CHC - CCB Practice Test Questions with Verified Solutions

CHC - CCB Practice Test Questions with Verified Solutions Organizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: a. Stark Laws b. ...

CHC - CCB Practice Test Questions with Verified Solutions Organizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: a. Stark Laws b. Deficit Reduction Act (DRA) c. Anti-Kickback (AKS) Law d. Sherman Antitrust Law ✔✔b. Deficit Reduction Act (DRA) An Organization identifies a potential issue when reviewing personal services and management contracts. Which of the following should the compliance professional consider in analyzing the issue? a. Deficit Reduction Act (DRA) b. Conditions of Participation (CoP) c. IRS tax-exempt guidelines d. Anti-Kickback (AKS) Safe Harbors ✔✔d. Anti-Kickback (AKS) Safe Harbors A hotline caller states the coding department was instructed to code based on LCD requirements regardless of medical record information. Which of the following should be the compliance professional's FIRST action? a. direct the coding supervisor to follow the applicable policy b. incorporate the coding issue into next year's risk assessment c. design a review to find facts and circumstances related to the compliant d. engage outside counsel to protect the underlying facts from discovery ✔✔c. design a review to find facts and circumstances related to the compliant In development of the annual work plan, physician contract compliance was prioritized as a high-risk area. When the compliance professional followed up with management, it appeared that the monitoring identified for this area was never put into place. Which of the following should be the compliance professional's FIRST step? a. Develop a corrective action plan b. Identify a statistically valid sample c. Conduct a probe sample d. Notify legal counsel ✔✔c. Conduct a probe sample A compliance professional identified an issue with medical necessity. The compliance professional should collaborate with the: a. case manager b. billing clerk c. documentation specialist d. patient account representative ✔✔a. case manager When non-compliance is substantiated, disciplinary action should be administered a. within 30 days b. if intent is proven c. in a consistent manner d. after completion of corrective action ✔✔c. in a consistent manner Which of the following is the BEST question to include in an employee exit interview? a. Why are you leaving your job? b. Did you ever observe anything that made you feel uncomfortable? c. How many times did you use the compliance hotline? d. Do you think your patients knew about the hotline? ✔✔b. Did you ever observe anything that made you feel uncomfortable? A compliance professional is conducting a policy review. Which of the following procedures MUST be included in the policy for statistically valid sampling and extrapolation? a. financial error rate exceeds 5% with a refund to occur within 60 days b. financial error rate exceeds 5% with a refund to occur within 90 days c. coding error rate exceeds 5% with a refund to occur within 60 days d. coding error rate exceeds 5% with a refund to occur within 90 days ✔✔a. financial error rate exceeds 5% with a refund to occur within 60 days Incentive programs based on employee performance may be tied to increases in a. the case mix index b. CPT/DRG codes c. patient referrals d. patient satisfaction ✔✔d. patient satisfaction A preliminary investigation identified payments to physicians for medical directorship without written contracts. Which of the following should be the compliance professional's NEXT step? a. determine if Medicare payments were received b. initiate a voluntary disclosure c. provide education to contracting office d. refund payments to the contractors ✔✔a. determine if Medicare payments were received In an investigation, the MOST important responsibility of the compliance professional is to a. personally conduct all investigations b. assure independence in investigations c. set the scope and sample size related to investigations d. remain within the budget for investigations ✔✔c. set the scope and sample size related to investigations A compliance professional discovers non-compliance with a regulation. Which of the following the compliance professional do FIRST? a. implement disciplinary actions b. conduct a baseline audit c. include it in the annual work plan d. develop a risk specific education plan ✔✔b. conduct a baseline audit A record retention policy must be based on a. AHIMA requirements b. applicable state laws c. state insurance commissioner's requirements d. applicable electronic health record constraints ✔✔b. applicable state laws Training is scheduled for employees to learn about cost reporting risks. This type of training is an example of a. online training b. general training c. focused training d. orientation training ✔✔c. focused training Which of the following are MOST relevant in evaluating the effectiveness of a compliance training program? 1. percent of target audience that has attended 2. whether the training is computer-based or classroom-based 3. whether training adequately addresses areas of concern 4. improvement shown in pre- and post-training quizzes A. 1, 2, 3 only B. 1, 2, 4 only C. 1, 3, 4 only D. 2, 3, 4 only ✔✔C. 1, 3, 4 only Quitam actions enable any person to bring forth an action to the a. employer, based upon original knowledge b. employer, based upon public information c. government, based upon public knowledge d. government, based upon original information ✔✔d. government, based upon original information An individual's understanding of the compliance aspects of their job can be BEST enhanced by including compliance in a. annual evaluations b. exit interviews c. HR benefit material d. audit committee meetings ✔✔a. annual evaluations Under HIPAA, a covered entity is required to disclose Protected Health Information (PHI) when: a. the disclosure is requested by the police department b. a subpoena signed by an attorney is received c. the disclosure is required by medical staff bylaws d. the Secretary of DHHS requests the information ✔✔d. the Secretary of DHHS requests the information The annual OIG work plan is a document that outlines the OIG's annual: a. staffing needs b. budget plans c. investigation ideas d. education agenda ✔✔c. investigation ideas Which of the following agencies indicate a self-evaluation after discovery of potentially fraudulent acts? a. CMS b. OIG c. OCR d. OSHA ✔✔b. OIG Reporting systems should be: a. marketed to contractors b. outsourced to a vendor c. operated by management d. publicized to all employees ✔✔d. publicized to all employees An employee reports a potential problem with the attending physician's presence for surgery. Which of the following is the compliance professional's BEST action? a. investigate the issue b. approach the surgeon c. notify the OIG d. request copies of the records ✔✔a. investigate the issue A compliance professional conducts an investigation into allegations of physicians and nurses taking pictures of injuries and posting them on a social network. It is confirmed that the two physicians and a nurse have engaged in this behavior. Which of the following is the compliance professional's and HR director's BEST action? a. review and adhere to the organization's disciplinary policy b. revoke the physician's hospital privileges, and terminate nurse c. report the incident to the Peer Review Committee and the nursing board d. notify the board of directors, and act according to their recommendations ✔✔a. review and adhere to the organization's disciplinary policy Coinsurance and deductibles can be waived a. for any federal payors b. during the admission process c. following payment to the third party d. if there is proven financial hardship ✔✔d. if there is proven financial hardship Corporate Integrity Agreements (CIA) are negotiated primarily between the: a. US attorneys and the hospital b. DOJ and the provider c. Federal Sentencing Commission and the organization d. OIG and the healthcare entity ✔✔d. OIG and the healthcare entity