CHC Compliance Program Administration 2 — Questions and Answers
Question 1: Which element of an effective compliance program focuses on identifying and addressing compliance risks before they result in violations?
- Reactive auditing
- Proactive risk assessment (Correct answer)
- Retrospective review
- Punitive enforcement
Correct answer: Proactive risk assessment
Proactive risk assessment identifies potential compliance vulnerabilities before they result in violations, allowing corrective action to be taken.
Question 2: A compliance officer discovers that a department manager has been retaliating against an employee who reported a compliance concern. What is the MOST appropriate immediate action?
- Issue a verbal warning to the manager
- Investigate the retaliation claim and protect the reporting employee (Correct answer)
- Transfer the reporting employee to another department
- Close the original compliance report
Correct answer: Investigate the retaliation claim and protect the reporting employee
Non-retaliation policies must be enforced by immediately investigating retaliation claims and protecting the employee who reported the concern.
Question 3: Under the OIG's guidance on compliance programs, what is the recommended frequency for conducting compliance risk assessments in a healthcare organization?
- Every five years
- Only when a new regulation is issued
- At least annually (Correct answer)
- Every time an employee is hired
Correct answer: At least annually
The OIG recommends conducting compliance risk assessments at least annually to keep pace with regulatory changes and organizational risks.
Question 4: Which of the following BEST describes the role of the compliance committee in a healthcare organization?
- Replacing the compliance officer's duties during vacations
- Providing oversight, guidance, and support for compliance program operations (Correct answer)
- Handling all employee grievances related to workplace issues
- Conducting annual financial audits
Correct answer: Providing oversight, guidance, and support for compliance program operations
The compliance committee provides oversight, guidance, and multidisciplinary support to help administer and strengthen the compliance program.
Question 5: What is the PRIMARY purpose of conducting exit interviews as part of a compliance program?
- To fulfill a legal requirement under HIPAA
- To gather information about potential compliance issues from departing employees (Correct answer)
- To determine compensation for final paychecks
- To update the employee's personnel file
Correct answer: To gather information about potential compliance issues from departing employees
Exit interviews can uncover compliance concerns that departing employees may be more willing to share when leaving the organization.
Question 6: A hospital compliance officer is developing metrics to measure the effectiveness of the compliance training program. Which metric is MOST directly relevant?
- Number of employees hired in the past year
- Pre- and post-training assessment scores (Correct answer)
- Total training budget spent
- Number of training sessions scheduled
Correct answer: Pre- and post-training assessment scores
Pre- and post-training assessment scores directly measure knowledge gained, making them the most relevant metric for training effectiveness.
Question 7: When a compliance officer identifies a significant potential overpayment to Medicare, what is the required timeframe for self-reporting under the 60-day rule?
- Within 30 days of identification
- Within 60 days of identification or when the overpayment is quantified (Correct answer)
- Within 90 days of the end of the fiscal year
- Within 180 days of the billing date
Correct answer: Within 60 days of identification or when the overpayment is quantified
The ACA's 60-day rule requires providers to report and return identified Medicare/Medicaid overpayments within 60 days of identification or quantification.
CHC Compliance Program Administration 2
Which element of an effective compliance program focuses on identifying and addressing compliance risks before they result in violations?