CHC Auditing and Monitoring 5

Question 1

What is the significance of the 'universe' in a compliance audit sampling context?

Accepted Answer

The total population of records or transactions from which the audit sample is drawn

Answer

The 'universe' refers to the entire population of records or claims subject to audit, from which a representative sample is selected.

Question 2

Which of the following BEST represents a 'proactive' audit in a compliance program?

Accepted Answer

A scheduled review of high-risk billing areas before any specific issue is identified

Answer

Proactive audits are scheduled in advance as part of the annual audit work plan to identify and correct issues before they become problems or attract external scrutiny.

Question 3

In the context of healthcare compliance, what does 'HEAT' stand for?

Accepted Answer

Health Care Fraud Prevention and Enforcement Action Team

Answer

HEAT (Health Care Fraud Prevention and Enforcement Action Team) is a joint DOJ and HHS initiative to prevent and combat Medicare and Medicaid fraud.

Question 4

Which type of audit compares an organization's compliance performance to industry norms or peer organizations?

Accepted Answer

Benchmarking audit

Answer

Benchmarking audits compare an organization's results to external standards, peer organizations, or industry averages to identify areas of relative risk or performance gaps.

Question 5

A compliance officer is reviewing the results of a claim audit and wants to report findings to leadership. Which metric BEST communicates the financial impact of identified errors?

Accepted Answer

The extrapolated overpayment amount based on the sample error rate

Answer

Extrapolating the sample error rate to the full population provides leadership with the estimated financial exposure, which is the most actionable compliance metric.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC Auditing and Monitoring 5