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HCCA - CHC Study Questions/ Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms/ 198 Q&A. $19.49
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HCCA - CHC Study Questions/ Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms/ 198 Q&A.
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HCCA - CHC Study Questions/ Content covers each compliance program element, HIPAA terms, compliance related laws & regulations, study materials, and general definitions and acronyms/ 198 Q&A. Which of the following requires providers to be permanently excluded from all federal health care progr...

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  • October 30, 2024
  • 248
  • 2024/2025
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HCCA - CHC Study Questions/ Content
covers each compliance program element,
HIPAA terms, compliance related laws &
regulations, study materials, and general
definitions and acronyms/ 198 Q&A.
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 - Answer: c. Balance Budget Act of 1997


Also known as a BBA "three strikes rule"

Page 1 of 248

,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. - Answer: 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 - Answer: c. Policy document


CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteria
Legal standards - mandatory action or rule


True or False:




Page 2 of 248

,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). - Answer: True


ref. ACA section 6102


According to HHS-OIG - what are three important reasons for proper
documentation in Compliance? (hint: protections) - Answer: 1. Protect our
programs
2.Protect your patients
3.Protect the Provider


https://oig.hhs.gov/newsroom/podcasts/2011/heat/heat09-
trans.asp#:~:text=Proper%20documentation%2C%20both%20in%20patients,to
%20protect%20you%20the%20provider.


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 - Answer: c. . third level of appeal


Frist level - redetermination by Medicare contractor
Second level - reconsideration by Independent contractor

Page 3 of 248

, 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. - Answer: 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 - Answer: c. non-retaliation for whistleblowers


A Compliance Program with well written policies and procedures:
a. can be successful if consistently reviewed and maintained

Page 4 of 248

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