HCA Certification Training Exam
Questions with Answers
True or False:
The ACA requires that all providers adopt a compliance plan as a condition of
enrollment with Medicare, Medicaid, and Children's Health Insurance
Program (CHIP). - -True
-According to HHS-OIG - what are three important reasons for proper
documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - -1.Protect our programs
2.Protect your patients
3.Protect the Provider
-At which level of the Medicare Part A or Part B appeals process is the
appeal decision by the Office of Medicare Hearings and Appeals (OMHA)?
a. first level of appeal
b. second level of appeal
c. third level of appeal
d. fourth level of appeal - -c. third level of appeal
-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. Leadership
skills, c. Skills to design and implement a compliance program, and d. Be
able to anticipate new risk areas.
-What is the appeals process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
,Fifth appeal - _________________________ - -Frist level - redetermination by
Medicare contractor
Second level - reconsideration by Independent contractor
Third appeal - Administrative Law Judge (ALJ) hearing
Fourth appeal - review by Medicare Appeals Council
Fifth appeal - review in Federal District Court
-Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline - -c. non-retaliation for whistleblowers
-A Compliance Program with well written policies and procedures:
a. can be successful if consistently reviewed and maintained
b. cannot be effective due to the sheer volume presented
c. will be effective if read by management
d. will not be successful without the proper oversight - -d. will not be
successful without the proper oversight
-A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - -b. increasing management involvement
-Which of the following requires providers to be permanently excluded from
all federal health care programs if found guilty of a healthcare related fraud
a third time:
a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128 - -c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
-Which statement is TRUE regarding compliance programs?
a. Compliance programs are considered more dangerous if they are
developed but not implemented.
b. Compliance programs can detect but not prevent criminal conduct
, c. Compliance programs are only required by law for healthcare entities that
have more than $500,000 in annual revenue.
d. Compliance programs are not mandated by law. - -a. Compliance
programs are considered more dangerous if they are developed but not
implemented.
-Formal statement outlining a plan for a specified subject area. It usually
cites state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - -c. Policy document
-Life cycle of records management
C
U
M
R
D - -Creation
Use
Maintenance
Retention
Disposition
-This demonstrates the organization's ethical attitude and its "enterprise-
wide" emphasis on compliance with all applicable laws and regulations - -
Policies and Procedures
-Code of Conduct: Content Checklist
1. Demonstrate ___________ _______ emphasis on _____________________ with all
applicable laws and regulations
2. _____________ plainly and concisely so all employees can understand the
standards
3. Includes ______________ and ______________ regulations
4. Mentions organizational ______________ without completely restating them
5. Is ______________ with company policies and procedures
6. Includes management's ___________________ to explain and enforce the
code - -1. Demonstrate system wide emphasis on compliance with all
applicable laws and regulations
2. Written plainly and concisely so all employees can understand the
standards
3. Includes internal and external regulations
4. Mentions organizational policies without completely restating them
Questions with Answers
True or False:
The ACA requires that all providers adopt a compliance plan as a condition of
enrollment with Medicare, Medicaid, and Children's Health Insurance
Program (CHIP). - -True
-According to HHS-OIG - what are three important reasons for proper
documentation in Compliance?
1.Protect our ___________________
2.Protect your ___________________
3.Protect the ___________________ - -1.Protect our programs
2.Protect your patients
3.Protect the Provider
-At which level of the Medicare Part A or Part B appeals process is the
appeal decision by the Office of Medicare Hearings and Appeals (OMHA)?
a. first level of appeal
b. second level of appeal
c. third level of appeal
d. fourth level of appeal - -c. third level of appeal
-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. Leadership
skills, c. Skills to design and implement a compliance program, and d. Be
able to anticipate new risk areas.
-What is the appeals process is the appeal decision by the Office of Medicare
Hearings and Appeals (OMHA)?
Frist level - _________________________
Second level - _________________________
Third appeal - _________________________
Fourth appeal - _________________________
,Fifth appeal - _________________________ - -Frist level - redetermination by
Medicare contractor
Second level - reconsideration by Independent contractor
Third appeal - Administrative Law Judge (ALJ) hearing
Fourth appeal - review by Medicare Appeals Council
Fifth appeal - review in Federal District Court
-Which of the following is an absolute necessity in order to have a successful
Compliance Program?
a. continuous training and improvements
b. effective reporting path
c. non-retaliation for whistleblowers
d. reliable and equal discipline - -c. non-retaliation for whistleblowers
-A Compliance Program with well written policies and procedures:
a. can be successful if consistently reviewed and maintained
b. cannot be effective due to the sheer volume presented
c. will be effective if read by management
d. will not be successful without the proper oversight - -d. will not be
successful without the proper oversight
-A Compliance Officer can achieve a higher level of compliance and ethics
engagement by:
a. ensuring leadership reads the policies
b. increasing management involvement
c. responding to compliance hotline calls
d. monitoring the code of conduct - -b. increasing management involvement
-Which of the following requires providers to be permanently excluded from
all federal health care programs if found guilty of a healthcare related fraud
a third time:
a. Deficit Reduction Act of 2005
b. False Claims Act
c. Balance Budget Act of 1997
d. Social Security Act section 1128 - -c. Balance Budget Act of 1997
Also known as a BBA "three strikes rule"
-Which statement is TRUE regarding compliance programs?
a. Compliance programs are considered more dangerous if they are
developed but not implemented.
b. Compliance programs can detect but not prevent criminal conduct
, c. Compliance programs are only required by law for healthcare entities that
have more than $500,000 in annual revenue.
d. Compliance programs are not mandated by law. - -a. Compliance
programs are considered more dangerous if they are developed but not
implemented.
-Formal statement outlining a plan for a specified subject area. It usually
cites state and/or federal required actions or standards.
a. CAP
b. Procedure document
c. Policy document
d. Legal standards - -c. Policy document
-Life cycle of records management
C
U
M
R
D - -Creation
Use
Maintenance
Retention
Disposition
-This demonstrates the organization's ethical attitude and its "enterprise-
wide" emphasis on compliance with all applicable laws and regulations - -
Policies and Procedures
-Code of Conduct: Content Checklist
1. Demonstrate ___________ _______ emphasis on _____________________ with all
applicable laws and regulations
2. _____________ plainly and concisely so all employees can understand the
standards
3. Includes ______________ and ______________ regulations
4. Mentions organizational ______________ without completely restating them
5. Is ______________ with company policies and procedures
6. Includes management's ___________________ to explain and enforce the
code - -1. Demonstrate system wide emphasis on compliance with all
applicable laws and regulations
2. Written plainly and concisely so all employees can understand the
standards
3. Includes internal and external regulations
4. Mentions organizational policies without completely restating them
