HCCA CHC UPDATED ACTUAL EXAM

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HCCA – CHC UPDATED ACTUAL EXAM

WITH CORRECT SOLUTIONS.

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). - correct answer- True

ref. ACA section 6102

According to HHS-OIG - what are three important reasons for

proper documentation in Compliance? (hint: protections) -

correct 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%20i n%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)? 1 / 4

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• first level of appeal
• second level of appeal
• third level of appeal
• fourth level of appeal - correct answer- 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.

• Leadership skills.
• Oversee the coding department.
• Skills to design and implement a compliance program.
• Be able to anticipate new risk areas.
• Practical experience with documenting medical necessity. -

correct answer- a. Leadership skills,

• Skills to design and implement a compliance program, and
• Be able to anticipate new risk areas.
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Which of the following is an absolute necessity in order to have a successful Compliance Program?

• continuous training and improvements
• effective reporting path
• non-retaliation for whistleblowers
• reliable and equal discipline - correct answer- c. non-

retaliation for whistleblowers

A Compliance Program with well written policies and

procedures:

• can be successful if consistently reviewed and maintained
• cannot be effective due to the sheer volume presented
• will be effective if read by management
• will not be successful without the proper oversight - correct

answer- d. will not be successful without the proper oversight

Regardless of having the best written policies in place that are reviewed/maintained consistently, and read and disseminated accordingly, will fail if there is no proper oversight to ensure they are actually being followed and understood.

A Compliance Officer can achieve a higher level of compliance

and ethics engagement by:

• ensuring leadership reads the policies 3 / 4

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• increasing management involvement
• responding to compliance hotline calls
• monitoring the code of conduct - correct answer- b.

increasing management involvement.

Compliance is everyone's responsibility, but management involvement is crucial. They have a direct contact with employees, they know and understand their staff's needs and concerns, and have the most influence over employee's actions and attitudes. Employees most likely use their direct manager(s) to raise concerns and the reason they are so critical for an organization to foster a culture of compliance.

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:

• Deficit Reduction Act of 2005
• False Claims Act
• Balance Budget Act of 1997
• Social Security Act section 1128d - correct answer- c.

Balance Budget Act of 1997

Also known as a BBA "three strikes rule"

What section of the ACA prevents discrimination against individuals with limited English proficiency (LEP), and also

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