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CHC Study Guide with Complete Solutions Federal Sentencing Guidelines - Culpability Score Aggravating Factors - ANSWER- 1. upper-level employee participates, condones, or ignores offense 2. repeat offense 3. hinder investigation 4. awareness and tolerance of violation is pervasive Federal Se...

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  • November 18, 2024
  • 101
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
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  • Prep Tests
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CHC Study Guide with Complete
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Federal Sentencing Guidelines - Culpability Score Aggravating Factors - ANSWER✔✔-

1. upper-level employee participates, condones, or ignores offense


2. repeat offense


3. hinder investigation


4. awareness and tolerance of violation is pervasive


Federal Sentencing Guidelines - Culpability Score Mitigating Factors - ANSWER✔✔-1.

effective compliance program


2. reported promptly


3. cooperation with investigation


4. accept responsibility


Federal Sentencing Guidelines - Seven Elements of an Effective Compliance Program -

ANSWER✔✔-1. written standards of conduct


2. Chief Compliance Officer


3. effective education and training

Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 1/101

,4. audits and evaluations to monitor compliance


5. reporting processes and procedures for complaints


6. appropriate disciplinary mechanisms


7. investigation and remediation of systematic problems


The only thing worse than not having a policy is... - ANSWER✔✔-...having a policy and

not following it.


Medicare reimbursement - hospital inpatient codes - ANSWER✔✔-International

Classification of Diseases (ICD)


Medicare reimbursement - physician codes - ANSWER✔✔-Current Procedural

Technology (CPT)


Questions to guide the scope of an internal investigation. - ANSWER✔✔-1. What is the

origin of the issue?


2. When did the issue originate?


3. How far back should the investigation go?


4. Can extrapolation of a statistical sample be used?


It is in the best interest of the organization to have the board _______. - ANSWER✔✔-

...take an active rather than a passive role in compliance.




Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 2/101

,Six tips for saving on future costs of compliance. - ANSWER✔✔-1. embed quality into

existing processes


2. centralize common processes and controls


3. improve human resources infrastructures


4. improve information systems processes


5. emphasize training


6. monitor marketing and compensation


Baseline Audit Process - ANSWER✔✔-1. outline the current operational standards


2. identify real and potential weaknesses


3. offer recommendations


Compliance Program - Measures of Effectiveness - ANSWER✔✔-1. staff knowledge


2. all 7 elements included


3. comparing issues year to year


4. tracking and trending complaints


5. tracking corrective actions


6. reviewing current audits


7. educational session pre and post tests



Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 3/101

, 8. tracking bill denials


9. organizational survey results


10. audit results


11. compliance topics on department/organization agendas


Modifier - ANSWER✔✔-a two digit alpha/numeric code used in conjunction with CPT

or HCPCS codes that may increase or decrease reimbursement




gives new meaning to the code


International Classification of Diseases (ICD) - ANSWER✔✔-a statistical classification

system that arranges diseases and injuries into groups according to established criteria

(signs and symptoms)


Current Procedural Terminology (CPT) - ANSWER✔✔-American Medical Association

publishes and maintains this coding system


Organized Health Care Arrangements (OHCA) - ANSWER✔✔-HIPAA arrangement

between clinically integrated setting (ex: hospitals and medical staff)


Diagnosis Related Group (DRG) - ANSWER✔✔-an inpatient classification system based

on: principal diagnosis, secondary diagnosis, surgical factors, age, sex, and discharge

status



Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 4/101

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