Compliance Program Administration Flashcards
7 cards from real CHC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance Program Administration flashcards as text
Which document outlines the standards of conduct and ethical expectations for all employees in a healthcare organization's compliance program?
Answer: The code of conduct
The code of conduct establishes the organization's ethical standards and behavioral expectations that all employees are required to follow.
A compliance officer at a large health system wants to benchmark the organization's compliance program. Which is the MOST credible benchmarking resource?
Answer: HCCA/OIG Healthcare Compliance Program Effectiveness Resource Guide
The HCCA/OIG Healthcare Compliance Program Effectiveness Resource Guide provides authoritative benchmarks and practices for evaluating compliance programs.
What does 'tone at the top' refer to in the context of healthcare compliance?
Answer: Leadership's demonstrated commitment to ethical behavior and compliance
Tone at the top refers to the culture of integrity set by senior leadership, which significantly influences employee compliance behavior throughout the organization.
In a Corporate Integrity Agreement (CIA), what is the role of the Independent Review Organization (IRO)?
Answer: To conduct independent reviews of claims and practices as required by the CIA
An IRO conducts independent, objective reviews of the organization's billing, coding, and other practices as specified in the CIA to verify compliance.
Which of the following scenarios BEST illustrates a conflict of interest that a compliance officer should address?
Answer: A physician who refers patients to a physical therapy clinic in which they have a financial interest
A physician referring patients to a facility in which they have a financial interest represents a classic conflict of interest and potential Stark Law violation.
What is the significance of conducting compliance program audits on a 'risk-stratified' basis?
Answer: It allocates audit resources to areas with the highest compliance risk first
Risk-stratified auditing directs compliance resources toward the areas most likely to have compliance issues, maximizing the program's effectiveness.
When developing a compliance training program, which population should receive the MOST specialized and detailed training content?
Answer: High-risk employees whose job functions directly involve regulated activities
Employees in high-risk roles—such as coders, billers, and clinicians—need specialized training tailored to the specific compliance risks associated with their duties.