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CHC Random Study Questions 2
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CHC Random Study Questions 2
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CHC Random Study Questions 2Fill in the blank:
The ___________ ____ Act further required that the HHS Secretary, in
consultation with HHS-OIG, establish "core elements" for provider and
supplier compliance programs within a particular industry or sector. - -
Affordable Care
Pursuant to 42 C.F.R. §§ 422.503(b)(4)(vi), 423.504(b)(4)(vi), and as
incorporated into Chapter 21, Section 30 of the "Medicare Managed Care
Manual":
All sponsors are required to adopt and implement an effective compliance
program, which must include measures to prevent, detect and correct Part C
or D program noncompliance as well as FWA. The compliance program must,
at a minimum, include the following core requirements: 1. Written Policies,
Procedures and Standards of Conduct; 2. Compliance Officer, Compliance
Committee and High Level Oversight; 3. Effective Training and Education; 4.
Effective Lines of Communication; 5. Well Publicized Disciplinary Standards;
6. Effective System for Routine Monitoring and Identification of Compliance
Risks; and 7. Procedures and System for Prompt Response to Compliance
Issues.
These seven elements are functionally equivalent to the seven elements of
an effective compliance plan identified by HHS-OIG in its publication,
Compliance Program for Individual and Small Group Physician Practices.
-Fill in the blanks:
The OIG CPG states: Standards of _______ should articulate hospital's
commitment to comply with Federal and state standards..... they should
state the organization's mission, goals, and ethical requirements of
compliance and reflect a carefully crafted, clear expression of expectations
for all hospital governing body members, officers, managers, employees,
physicians, and, where appropriate, _______ and other agents. - -conduct;
contractors
-You are the new Compliance Officer, hired after ABC Hospital reorganized
and decided that the General Counsel should no longer also serve in that
role. Upon review of the Code of Conduct (CoC), you find that it is written
using lots of legal jargon. What action do you take:
a. Keep CoC as it is.
b. Pull a sample off the internet and insert hospital name to save time as it
was most likely written by experts.
c. Rewrite the CoC in plain and concise language tailored to the hospital so
employees can use a general guidance.
d. Rewrite the CoC with detailed restating hospital's P&Ps, and all laws and
regulations possible so that employees can't say they were not aware of
,requirements. - -c. Rewrite the CoC in plain and concise language tailored to
the hospital so employees can use a general guidance.
Explanation:
CoC should be clear and concise language easy to understand, and should be
tailored to specific issues of the organization
-What should CCO be able to do? (What skills should this person have?)
Choose all that apply.
a. Leadership skills.
b. Oversee the coding department.
c. Skills to design and implement a compliance program.
d. Be able to anticipate new risk areas.
e. Practical experience with documenting medical necessity. - -a. c. and d.
-Life cycle of records management - -Creation
Use
Maintenance
Retention
Disposition
-New Employee Policy - three checks OIG recommends to do/perform: - -OIG
recommends: perform background checks, reference checks, and exclusion
list checks
-Which of the following is responsible for clinical trial billing compliance and
enforcement:
a. FDA
b. OIG
c. ORI
d. OCR - -b. OIG
-ABC Hospital is under a 5-year CIA with government-imposed requirements
for development of a Compliance Program and use of external auditor for
periodic claim reviews. Which of the following is TRUE:
a. Costs to meeting terms of the CIA are permitted to be included in the cost
report like any other operational cost.
b. Because the hospital agreed to a settlement and was not convicted for
alleged violations, the Compliance Program is considered a voluntary
program.
c. The government chooses and pays for the external auditors.
d. None of the above - -d. None of the above.
Explanation:
• CIA-related costs CANNOT be included in the cost report.
, • Government-imposed Compliance Program ARE NOT considered a
voluntary program.
• Hospital is required to choose and pay for any auditors (with government
review and right to object)
-The IRO is conducting a Claim Review for a hospital under a CIA and
discovers that there is a discrepancy between the dollar difference between
the amount that was reimbursed and the amount that should have been
reimbursed when conducting a Discovery Sample. Which of the following is
false:
a. The dollar difference resulted in an overpayment. And when converted to
percentage, the resulting calculation is the error rate
b. The net financial error rate calculated was under 10%, no need to conduct
a Full Sample
c. If the net financial error rate of the Discovery Sample is below 5%, the
review is complete
d. A and C - -b. The net financial error rate calculated was under 10%, no
need to conduct a Full Sample
According to the OIG, a Full Sample size is only required if the net financial
error rate of the Discovery Sample equals or exceeds 5%.
https://oig.hhs.gov/faqs/corporate-integrity-agreements-faq.asp
-February 27, 1997, what does this date represent? - -Date of OIG open
letter to all providers - encourages health care organization to implement
compliance programs in order to protect themselves from fraud and abuse.
With that letter, Model compliance plan for Clinical Laboratory was offered as
guidance. Since that time, a Model compliance plan has been implemented
in many areas.
-HCCA prepared and published Code of Ethics for Health Care Compliance
Professional addressing 3 principles - -Principle 1 - Obligation to public
Principle 2 - Obligation to employing organization - should serve organization
with highest sense of integrity, unprejudiced, and unbiased judgment
Principle 3 - Obligation to the profession - uphold integrity and dignity of
profession, to advance effectiveness of compliance program and to promote
professionalism in health care compliance
Ref:
https://assets.hcca-info.org/Portals/0/PDFs/Resources/HCCACodeOfEthics.pdf
-OIG Work Plan, what's its main purpose? - -Identifies high risk & key areas
of focus for auditing. Active Work Plan Items reflect OIG audits, evaluations,
and inspections that are underway or planned. Ref:
https://oig.hhs.gov/reports-and-publications/workplan/index.asp
-The Federal Sentencing Guidelines uses key mitigating factors, which are:
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