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

Auditing is a formal, periodic evaluation conducted by an independent party (like internal audit or an external firm) to ensure objectivity. Monitoring consists of ongoing, routine activities conducted by management and operational staff to ensure processes are working as intended.

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

A comprehensive risk assessment is the foundational element of an effective compliance program and should be the starting point for developing a risk-based audit plan. This process identifies and prioritizes the organization's specific risks, which then guides the focus of audit activities. The other options are valuable inputs to the risk assessment but are not the first or most critical step.

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

A small, non-statistical sample is not sufficient to draw conclusions about the overall error rate or financial impact. The best practice is to expand the review to a statistically valid random sample to accurately quantify the scope and magnitude of the issue before determining appropriate corrective action, such as education or repayment.

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

Ongoing monitoring is designed to be a continuous process that allows for the early detection of potential compliance issues, enabling prompt correction before they become systemic problems. Audits, by contrast, are periodic, point-in-time assessments.

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

Stratified random sampling involves dividing the entire population of claims into different subgroups, or 'strata'—in this case, by dollar value. A random sample is then taken from each stratum. This method ensures that high-risk areas, such as high-dollar claims, are included in the audit sample, providing a more targeted and risk-based review than a simple random sample might.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

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