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HCCA - CHC Study Questions (MASTER FLASHCARDS)/762 Q’S AND A’S (Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms)£16.19
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HCCA - CHC Study Questions (MASTER FLASHCARDS)/762 Q’S AND A’S (Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms)
HCCA - CHC Study Questions (MASTER FLASHCARDS)/762 Q’S AND A’S (Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms)
HCCA - CHC Study Questions (MASTER
FLASHCARDS)/762 Q’S AND A’S (Content
covers each compliance program element,
HIPAA terms, compliance related laws &
regulations, study materials, and general
definitions and acronyms)
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
ref. ACA section 6102
-According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) - -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
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
https://www.hhs.gov/about/agencies/omha/the-appeals-process/index.html
-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.
-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
CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule
-Life cycle of records management - -Creation
Use
Maintenance
Retention
Disposition
-Standards of Conduct (written P&Ps) - -Demonstrate the organization's
ethical attitude and its "enterprise-wide" emphasis on compliance with all
applicable laws and regulations
-Code of Conduct: Content Checklist - -• Demonstrate system wide
emphasis on compliance with all applicable laws and regulations
• Written plainly and concisely so all employees can understand the
standards
• Includes internal and external regulations
• Mentions organizational policies without completely restating them
• Is consistent with company policies and procedures
• Includes management's responsibility to explain and enforce the code
-Code of Conduct and Employees - -All employees must receive, read, and
understand the standards.
A supervisor should explain the standards and answer any questions.
Employee should attest in writing that they have received, read, and
understood the standards
Employee compliance with standards must be enforced through appropriate
discipline when necessary
Discipline for non-compliance should be stated in the standards
-Code of Conduct Purpose - -• To present specific guidelines for employees
to follow
• To confirm that all employees comprehend what is required of them
, • To provide a process for proper decision making
• To confirm that employees put standards into everyday practice
• To elevate corporate performance in basic business relationship
• To confirm that the organization upholds and supports proper compliance
conduct
-Every organization needs policies and procedures for: - -• Internal
assessments
• Record retention (where, how long)
• Self-disclosure
• Medicare sanction checks (LEIE)
• Billing policies
• Credit balance
• No charge visits
• Incomplete/unsuccessful procedure
• Documentation requirements
-When should Code of Conduct be distributed to new employees? - -Must be
distributed within 90 days of hire
-RAT-STATS is: (select all that apply)
a. statistical software to select randomized samples
b. government statistical rule software developed in the 1970s
c. free hospital statistical software
d. recommended by OIG, CMS and other agencies to select random samples
- -a. b. d.
The software can be used by other entities other than hospitals, so option
"c." is not precisely accurate, but it is free to use and can be downloaded
here: https://oig.hhs.gov/compliance/rat-stats/index.asp
-What is the term called for an organization's commitment to compliance by
management, employees, and contractors. Statement should summarize
ethical behavior and legal principles under which the healthcare organization
operates? - -Code of Conduct
-In the course of an audit, you find that disciplinary actions against certain
physicians and high level executives for non-compliance in the organization
have been unfair and inconsistent with current policies & procedures. What
is your first course of action
.a. Work with legal counsel to enforce proper disciplinary actions
b. Get HR involved and recommend the use of progressive discipline policies
c. Immediately terminate these individuals
d. Get local and federal labor department involved for unfair discipline. - -b.
Get HR involved and recommend the use of progressive discipline policies
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