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HCCA |- |CHC |Study |Questions |with |correct |
and |verified |answers
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 |ANSWERS |✔✔True ref. |ACA |section | 6102 According |to |HHS-OIG |- |what |are |three |important |reasons |for | proper |documentation |in |Compliance? |(hint: |protections) |- |CORRECT | ANSWERS |✔✔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 |- |CORRECT |ANSWERS |✔✔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. |- | CORRECT |ANSWERS |✔✔a. |Leadership |skills, c. |Skills |to |design |and |implement |a |compliance |program, |and
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 |- |CORRECT |ANSWERS |✔✔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: a. |Deficit |Reduction |Act |of | 2005 b. |False |Claims |Act c. |Balance |Budget |Act |of | 1997 d. |Social |Security |Act |section |1128d |- |CORRECT |ANSWERS |✔✔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 |prohibits | discrimination |in |healthcare |programs |and |activities |that |receive | federal |funding, |based |on |race, |color, |national |origin, |sex, |age, |or | disability. a. |ACA |section | 6102 b. |ACA |section | 1557 c. |ACA |section | 6002 |- |CORRECT |ANSWERS |✔✔b. |ACA |section | 1557 | is |the |correct |answer. a. |ACA |section | 6102 |requires |owners, |operators, |and |administrators | of |LTC |facilities |to |adopt |effective |compliance. c. |ACA |section | 6002 |requires |the |establishment |of |a |transparency | program, |now |known |as |CMS |Open |Payments. 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
Legal |standards |- |mandatory |action |or |rule Life |cycle |of |records |management |- |CORRECT |ANSWERS |✔✔Creation Use Maintenance Retention Disposition Standards |of |Conduct |(written |P&Ps) |- |CORRECT |ANSWERS | ✔✔Demonstrate |the |organization's |ethical |attitude |and | its |"enterprise-wide" |emphasis |on |compliance |with |all |applicable | laws |and |regulations Code |of |Conduct: |Content |Checklist |- |CORRECT |ANSWERS |✔✔• | 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
Ref: |SCCE |Compliance |& |Ethics |Manual, |Chapter | 2 https://compliancecosmos.org/essential-elements-effective-ethics-and- compliance-program Code |of |Conduct |and |Employees |- |CORRECT |ANSWERS |✔✔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 |- |CORRECT |ANSWERS |✔✔• |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
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? |- |CORRECT | ANSWERS |✔✔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. |- |CORRECT |ANSWERS |✔✔b. |Get |HR |involved |and | recommend |the |use |of |progressive |discipline |policies OIG |recommends |setting |forth |the |degrees |of |disciplinary |actions. | Progressive |discipline |provides |a |structure |and |a |set |of |discipline |
standards |for |managers/supervisors |to |follow |to |ensure |discipline | is |fair, |equitable |and |consistent. Documentation |- |CORRECT |ANSWERS |✔✔• |A&M |should |be | documented |
- |Findings |should |be |shared |with |dept |managers |
- |If |activity |is |part |of |risk |priority |then |compliance |committee, | senior |leadership |and |board |when |necessary |
- |OIG |calls |for |written |evaluation |to |be |presented |to |CEO, |governing |body, |committee |annually Non-retaliation |in |compliance |- |what |is |important |to |state |in |this | policy: |- |CORRECT |ANSWERS |✔✔For |any |reporting |method |to |be | effective, |employees |must |accept |that |there |will |be |no |retaliation | or |retribution |for |coming |forward. The |concept |of |non-retaliation |is |fundamental |to |the |compliance | program, |and |a |clearly |stated |policy |regarding |non-retribution |is |the |first |step. |
- |anonymous |reporting |and,
- |no |retaliation |or |retribution |for |bringing |forth |problems/concerns Place |to |start |with |Enforcement |is: |- |CORRECT |ANSWERS | ✔✔Standards |of |conduct |and |P&Ps
d. |Rewrite |the |CoC |with |detailed |restating |hospital's |P&Ps, |and |all | laws |and |regulations |possible |so |that |employees |can't |say |they | were |not |aware |of |requirements. |- |CORRECT |ANSWERS |✔✔c. |Rewrite |the |CoC |in |plain |and |concise |language |tailored |to |the |hospital |so | employees |can |use |a |general |guidance. Explanation:
- |CoC |should |be |clear |and |concise |language |easy |to |understand, | and |should |be |tailored |to |specific |issues |of |the |organization What |is |the |term |called |for |an |organization's |commitment |to | compliance |by |the |board, |management, |and |employees? |It | summarizes |ethical |behavior |and |legal |principles |the |healthcare | organization |operates. A) |Code |of |Conduct B) |Federal |Sentencing |Guidelines C) |Internal |Controls |- |CORRECT |ANSWERS |✔✔A) |Code |of |Conduct The |U.S. |Federal |Sentencing |Commission |was |organized |in |_____, | published |its |initial |set |of |guidelines |manual |in |_____ |(known |today | as |the |US |Sentencing |Guidelines), |and |included |chapter |eight |of | the |Federal |Sentencing |Guidelines |for |Organizations |in |_____. a. |1980, |1987, | 1999 b. |1985, |1987, | 1991
c. |1980, |1985, | 1987 d. |1985, |1990, | 2001 |- |CORRECT |ANSWERS |✔✔b. |1985, |1987, | 1991 The |US |Sentencing |Guidelines |(USSG) |can |be |found | here: |https://www.ussc.gov/guidelines. Chapter | 8 |- |Sentencing |of |organizations, |includes |Parts |A-F |(Part |B | 2.b.1 |outlines |the |Compliance |and |Ethics |Program) Expectations |have |evolved |since | 1991 |when |the |US |Sentencing | Guidelines |(USSG) |were |first |drafted |highlighting |the |importance |of | an |effective |compliance |program |(and |as |a |condition |of |probation) | to |help |detect |criminal |conduct |(USSG |chapter |8B2.1). |DOJ |has |now | set |higher |expectations |for |organizations |to |not |only |have |a | designated |compliance |officer |but |a |well |designed |compliance | program |that |is |adequately |resourced |with |independent |authority | function |to |work |in |practice. |Which |of |the |following |guidelines | outlines |those |expectations: a. |HHS |OIG |- |CPG |(Compliance |Program |Guidance) b. |DOJ |ECCP |(Evaluation |of |Corporate |Compliance |Programs) c. |Monaco |Memo d. |HHS |OIG |- |CIA |(Corporate |Integrity |Agreement) |- |CORRECT | ANSWERS |✔✔b. |DOJ |ECCP |(Evaluation |of |Corporate |Compliance | Programs)
C. |Post |a |copy |of |the |new |NPP |on |the |hospital's |internal |intranet | so |that |all |employees |can |see |the |updated |version |of |the |notice D. |Meet |with |legal |to |discuss |how |to |best |self-disclose |to |OCR |that | the |hospital |was |in |violation |of |the |NPP |requirements |and |has |since |corrected |the |deficiency |- |CORRECT |ANSWERS |✔✔B. |Make | arrangements |to |have |the |new |NPP |distributed |to |new |patients |that |come |to |the |hospital Remember: |The |NPP |must |describe |the |following |individual |rights: | https://www.law.cornell.edu/cfr/text/45/164.
- |The |right |to |request |restrictions |on |uses |or |disclosures |of |PHI |for | treatment, |payment |or |healthcare |operations; |for |use |in |a |facility | directory |(if |applicable); |or |to |family |members |and |others |involved | in |the |patient's |care; |however, |the |provider |is |not |required |to |agree | to |the |restriction |except |in |the |case |of |a |disclosure |to |a |health | insurer |if |the |individual |has |paid |for |the |care |as |required |by §164.522(a)(1)(vi). |This |is |a |change |necessitated |by |the |Omnibus | Rule.
- |The |right |to |receive |confidential |communications |by |alternative | means |or |at |alternative |locations |per |§164.522(b).
- |The |right |to |inspect |and |copy |PHI |per |§ |164.524. |The |provider | may |want |to |include |a |statement |that |the |provider |may |charge |a | reasonable |cost-based |fee |for |copies.
- |The |right |to |amend |PHI |per |§ |164.526.
- |The |right |to |receive |an |accounting |of |disclosures |of |PHI |as | provided |by |§ |164.528.
- |The |right |to |receive |a |paper |copy |of |the |NPP |upon |request.
- |A |brief |description |of |how |the |individual |may |exercise |the | foregoing |rights, |e.g., |by |submitting |a |written |request |to |the | provider's |privacy |officer. What |is |the |best |definition |of |Medicare/Medicaid |fraud? a. |Attempting |a |scheme |against |the |Medicare/Medicaid |program b. |Knowingly |executing |a |scheme |against |the |Medicare/Medicaid | program c. |Willfully |executing |a |scheme |against |the |Medicare/Medicaid | program d. |All |of |the |above |- |CORRECT |ANSWERS |✔✔d. |All |of |the |above Remember: |Fraud |is |generally |defined |as |knowingly |and |willfully | executing, |or |attempting |to |execute, |a |scheme. FRAUD |is |intentional; WASTE |is |overuse/misuse |of |resources |carelessly; ABUSE |on |the |other |hand, |does |not |require |poof |of |intent, |but |it's | improper |practice |leading |to |unnecessary |expenses What |is |the |best |definition |of |Medicare/Medicaid |abuse? a. |Knowingly |defrauding |the |Medicare/Medicaid |program b. |Intentionally |violating |Medicare/Medicaid |guidelines
d. |created |to |combat |Medicare |provider |FWA |- |CORRECT |ANSWERS | ✔✔a. |established |by |the |DRA |of | 2005 |(section |6034) https://www.ssa.gov/OP_Home/comp2/F109-171.html Notes: b. |federally |administered |and |state |monitored |(the |opposite) c. |audited |by |MACs |(MAC |is |for |Medicare. |MIPs |are |audited |by | MICs) d. |created |to |combat |Medicare |provider |FWA |(Medicaid, |not | Medicare) Reporting |systems |should |be: a. |marketed |to |contractors b. |outsourced |to |a |vendor c. |operated |by |management d. |publicized |to |all |employees |- |CORRECT |ANSWERS |✔✔d. | publicized |to |all |employees Are |providers |financially |liable |if |their |billing |services |commit |fraud | without |the |provider's |knowledge? |Yes
|No |- |CORRECT |ANSWERS |✔✔Yes |- |they |are |financially |liable |for |all | claims |submitted |on |their |behalf |that |contain |their |identification | number Regarding |patient |credit |balances, |which |of |the |following |are |good | practices |for |addressing |credit |balance |compliance |risks: a. |Review |reporting |capability |as |most |EHRs |can |detect |a |credit | balance |issue. b. |Perform |root-cause |analysis |to |determine |the |direct |source |of | overpayment, |and |ongoing |monitoring c. |Perform |random |audits |and |report |findings |to |ensure |proper | monitoring |and |corrective |action. d. |all |of |the |above |- |CORRECT |ANSWERS |✔✔d. |all |of |the |above | Having |a |clear |P&P |on |overpayments, |self-disclosure |and |credit | balances |is |also |recommended |to |stay |up |to |date |with |regulatory | changes |and |avoid |any |penalties 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
