CHC Auditing and Monitoring 3

Question 1

In a stratified sampling approach for a compliance audit, what is the main advantage over simple random sampling?

Accepted Answer

It ensures proportional representation of distinct subgroups within the population

Answer

Stratified sampling divides the population into subgroups (strata) and samples from each, ensuring all relevant categories are represented in the audit.

Question 2

What is 'extrapolation' in the context of a Medicare compliance audit?

Accepted Answer

Projecting the findings from a sample to estimate the error across the entire claim population

Answer

Extrapolation uses the error rate found in the sample to estimate the total overpayment or error amount across the full billing population.

Question 3

Which element is NOT typically included in a formal audit report?

Accepted Answer

Personal opinions of individual staff members

Answer

Formal audit reports are objective documents; they include scope, methodology, findings, and recommendations, but not personal opinions of staff.

Question 4

A healthcare organization's compliance monitoring program flags an unusually high rate of modifier 25 usage. What is the BEST next step?

Accepted Answer

Conduct a focused audit to determine if the modifier is being used appropriately

Answer

A focused audit investigates the specific flagged issue to determine root cause and whether the modifier is being appropriately applied before taking further action.

Question 5

What role does a 'work plan' serve in an OIG compliance context for healthcare organizations?

Accepted Answer

It is the annual list of OIG audit and enforcement priorities used to guide internal compliance focus

Answer

The OIG Work Plan identifies the areas the OIG plans to review, helping healthcare organizations prioritize their own internal auditing and monitoring efforts.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC Auditing and Monitoring 3