CHC Random Study Questions 1|
WITH 100% CORRECT ANSWERS
Compliance means (Compliance Program) Correct Answer: Adherence to laws and regulations,
as well as principles of ethical conduct
OIG urges the ____________ to assist in the implementation of the compliance program and
serves as advisors.
A. Board
B. CEO
C. Compliance Committee
D. Quality Committee Correct Answer: C. Compliance Committee
A compliance professional is reviewing the policies and procedures for exclusion verifications.
The policy does not state frequency of exclusion verifications. How frequent should exclusion
verifications be performed?
a. Annually
b. Bi-annually
c. Monthly
d. Semi-annually Correct Answer: c. monthly (as recommended by OIG to avoid risk)
A hospital medical staff office is conducting its monthly review of the Excluded Parties List
System (EPLS). The compliance officer is called by the manager of the medical staff office and
informed that Dr. Smith, a surgeon who took call 5 times last month for the Emergency
Department, was excluded on a date prior to those dates when the surgeon took call. In other
words, the effective date of the exclusion involving the surgeon was 4/1/2019 and the surgeon
took call and provided surgical services to patients in the ED on 4/13/19, 4/20/19, and 4/27/2019.
What is the NEXT action the compliance officer should do?
a. Contact the ED and make sure that the involved surgeon is removed from taking any more on
call shifts.
b. Have the medical office check if the surgeon is listed on other exclusion lists.
c. Contact legal counsel to alert of the need to pay back reimbursement received for services
provided by an excluded individual.
d. Hold all surgical service related bills associated with the ED so that none are released to any
payers which may involve this surgeon. Correct Answer: b. Have the medical office check if the
surgeon is listed on other exclusion lists
OIG can impose mandatory exclusion for a minimum of..? Correct Answer: 5 years
True or False:
An excluded individual is automatically reinstated at the end of an exclusion term Correct
Answer: FALSE - An excluded individual must apply for reinstatement at the end of their
exclusion term
, A privacy professional is reviewing a program for an academic medical center that include a
faculty group practice, hospital, student health center, and self-funded group health plan. The
privacy professional should evaluate if the program has notices for:
a. GINA
b. FMLA
c. HIPAA
d. FISMA Correct Answer: c. HIPAA
A health system implemented an EHR in 55 clinics. The privacy professional is told employees
are inconsistently interpreting the policy addressing employee access to EHR. Which of the
following is the privacy professional's BEST strategy?
a. Collaborate with HR to ensure appropriate discipline
b. Perform an audit under Attorney-Client Privilege
c. Conduct surveys of clinic employees concerns
d. Audit a random sampling of clinics across the organization Correct Answer: c. Conduct
surveys of clinic employees concerns
Under the US Federal Sentencing Guidelines, there is an expectation that effective compliance
programs include due diligence in discretionary authority and hiring. Which of the following is
MOST important process to include?
a. Periodic background checks
b. Drug Testing
c. Monthly exclusion verifications through OIG database
d. Monthly exclusion verifications through SAMS GSA Exclusion database Correct Answer: d.
Monthly exclusion verifications through SAMS GSA Exclusion database.
Explanation: Starting from the top: GSA administers SAM, which contains debarment actions
taken by various Federal agencies, including OIG's exclusions. The LEIE contains only the
exclusion actions taken by OIG.
What are the 2 types of OIG exclusions? Correct Answer: Mandatory and Permissive.
See definitions: https://oig.hhs.gov/exclusions/background.asp
Concurrent Audit Correct Answer: Real time - Ongoing review/inspection of records, policies
and procedures. More difficult to execute but best way to change behavior. Identify and address
problems as they arise - Example: Auditing claims before claims are billed
What is DRG Creep Correct Answer: Using a Diagnosis Related Group (DRG) code that
provides a higher payment rate than the DRG code that accurately reflects the service furnished
to the patient.
In Compliance Auditing & Monitoring, Contemporaneous Reviews:
a. Involves matter that either have not yet been billed by provider or have not yet been paid by
the third party payor
WITH 100% CORRECT ANSWERS
Compliance means (Compliance Program) Correct Answer: Adherence to laws and regulations,
as well as principles of ethical conduct
OIG urges the ____________ to assist in the implementation of the compliance program and
serves as advisors.
A. Board
B. CEO
C. Compliance Committee
D. Quality Committee Correct Answer: C. Compliance Committee
A compliance professional is reviewing the policies and procedures for exclusion verifications.
The policy does not state frequency of exclusion verifications. How frequent should exclusion
verifications be performed?
a. Annually
b. Bi-annually
c. Monthly
d. Semi-annually Correct Answer: c. monthly (as recommended by OIG to avoid risk)
A hospital medical staff office is conducting its monthly review of the Excluded Parties List
System (EPLS). The compliance officer is called by the manager of the medical staff office and
informed that Dr. Smith, a surgeon who took call 5 times last month for the Emergency
Department, was excluded on a date prior to those dates when the surgeon took call. In other
words, the effective date of the exclusion involving the surgeon was 4/1/2019 and the surgeon
took call and provided surgical services to patients in the ED on 4/13/19, 4/20/19, and 4/27/2019.
What is the NEXT action the compliance officer should do?
a. Contact the ED and make sure that the involved surgeon is removed from taking any more on
call shifts.
b. Have the medical office check if the surgeon is listed on other exclusion lists.
c. Contact legal counsel to alert of the need to pay back reimbursement received for services
provided by an excluded individual.
d. Hold all surgical service related bills associated with the ED so that none are released to any
payers which may involve this surgeon. Correct Answer: b. Have the medical office check if the
surgeon is listed on other exclusion lists
OIG can impose mandatory exclusion for a minimum of..? Correct Answer: 5 years
True or False:
An excluded individual is automatically reinstated at the end of an exclusion term Correct
Answer: FALSE - An excluded individual must apply for reinstatement at the end of their
exclusion term
, A privacy professional is reviewing a program for an academic medical center that include a
faculty group practice, hospital, student health center, and self-funded group health plan. The
privacy professional should evaluate if the program has notices for:
a. GINA
b. FMLA
c. HIPAA
d. FISMA Correct Answer: c. HIPAA
A health system implemented an EHR in 55 clinics. The privacy professional is told employees
are inconsistently interpreting the policy addressing employee access to EHR. Which of the
following is the privacy professional's BEST strategy?
a. Collaborate with HR to ensure appropriate discipline
b. Perform an audit under Attorney-Client Privilege
c. Conduct surveys of clinic employees concerns
d. Audit a random sampling of clinics across the organization Correct Answer: c. Conduct
surveys of clinic employees concerns
Under the US Federal Sentencing Guidelines, there is an expectation that effective compliance
programs include due diligence in discretionary authority and hiring. Which of the following is
MOST important process to include?
a. Periodic background checks
b. Drug Testing
c. Monthly exclusion verifications through OIG database
d. Monthly exclusion verifications through SAMS GSA Exclusion database Correct Answer: d.
Monthly exclusion verifications through SAMS GSA Exclusion database.
Explanation: Starting from the top: GSA administers SAM, which contains debarment actions
taken by various Federal agencies, including OIG's exclusions. The LEIE contains only the
exclusion actions taken by OIG.
What are the 2 types of OIG exclusions? Correct Answer: Mandatory and Permissive.
See definitions: https://oig.hhs.gov/exclusions/background.asp
Concurrent Audit Correct Answer: Real time - Ongoing review/inspection of records, policies
and procedures. More difficult to execute but best way to change behavior. Identify and address
problems as they arise - Example: Auditing claims before claims are billed
What is DRG Creep Correct Answer: Using a Diagnosis Related Group (DRG) code that
provides a higher payment rate than the DRG code that accurately reflects the service furnished
to the patient.
In Compliance Auditing & Monitoring, Contemporaneous Reviews:
a. Involves matter that either have not yet been billed by provider or have not yet been paid by
the third party payor
