CHC - Certified in Healthcare Compliance Auditing and Monitoring Questions and Answers

Question 1

A key distinction between auditing and monitoring within a healthcare compliance program is that auditing is typically performed by:

Accepted Answer

An independent party, while monitoring is an ongoing operational management function.

Answer

The compliance officer, while monitoring is performed by the board of directors.

Answer

External consultants exclusively, while monitoring is done by internal staff.

Answer

The operational department manager, while monitoring is conducted by the compliance department.

Question 2

A hospital's compliance officer is developing the annual audit plan. Which of the following is the most critical first step in this process?

Accepted Answer

Conducting a comprehensive risk assessment.

Answer

Reviewing the previous year's audit findings.

Answer

Interviewing department heads about their concerns.

Answer

Analyzing the OIG's most recent Work Plan.

Question 3

During a routine internal audit of physician billing, a small sample of 10 claims for a specific high-level E/M code reveals a 30% error rate due to insufficient documentation. What is the compliance professional's BEST next step?

Accepted Answer

Expand the audit to a statistically valid random sample to determine the scope of the problem.

Answer

Immediately report the physician to the OIG for potential fraud.

Answer

Provide mandatory, system-wide training on E/M coding for all providers.

Answer

Discipline the physician for failing the audit.

Question 4

Which of the following best describes the primary purpose of ongoing monitoring activities in a healthcare compliance program?

Accepted Answer

To detect and correct compliance issues in real-time or near real-time.

Answer

To provide an annual, independent assessment of the compliance program's effectiveness.

Answer

To satisfy the requirements of external government auditors.

Answer

To serve as the sole basis for employee disciplinary actions.

Question 5

When selecting a sample for an audit of claims, which methodology is most appropriate for ensuring that high-dollar claims are adequately represented in the review?

Accepted Answer

Stratified random sampling

Answer

Systematic sampling

Answer

Simple random sampling

Answer

Convenience sampling

Question 6

According to the OIG, an effective compliance program includes auditing and monitoring as one of its seven core elements. The primary goal of this element is to:

Accepted Answer

Evaluate the effectiveness of the compliance program and detect offenses.

Answer

Guarantee the organization will pass all external government investigations.

Answer

Assign blame for compliance failures to specific individuals.

Answer

Reduce the compliance department's annual budget by identifying efficiencies.