CHC - Certified in Healthcare Compliance Standards, Policies, and Procedures Questions and Answers

Question 1

A healthcare organization is developing its compliance program. Which of the following BEST distinguishes between policies and procedures?

Accepted Answer

Policies are high-level statements of management's intent and values, while procedures provide mandatory, step-by-step instructions to implement those policies.

Answer

Policies are broad, high-level statements that communicate management's intent, goals, and the organization's values. Procedures are the detailed, mandatory, step-by-step instructions that describe how to carry out a policy. For example, a policy might state that the organization will protect patient information, while a procedure would outline the specific steps for accessing, sharing, and destroying PHI.

Question 2

When implementing new and revised compliance policies, which of the following is the MOST critical initial step to ensure effectiveness and adoption by staff?

Accepted Answer

Developing a clear communication and training plan tailored to different audiences.

Answer

Effective implementation hinges on ensuring staff understand the new policies and their importance. A clear communication and training plan is the most critical first step to achieve this understanding. While distribution is part of communication, a comprehensive plan includes training, opportunities for questions, and explaining the 'why' behind the policy, which is essential for buy-in and adherence.

Question 3

A compliance officer at a large hospital system discovers that a recently implemented billing procedure conflicts with a long-standing coding policy, leading to claim submission errors. What is the BEST course of action for the compliance officer?

Accepted Answer

Convene relevant stakeholders to review the conflict, revise the documents for consistency, and provide education on the corrected process.

Answer

The best course of action is to address the problem systematically. This involves bringing together the relevant parties (e.g., from billing, coding, and compliance) to understand the discrepancy, revise the policy and/or procedure to ensure they are aligned and compliant, and then re-educate the staff on the correct, harmonized process. This approach corrects the root cause and prevents future errors.

Question 4

According to the OIG's Seven Elements of an Effective Compliance Program, written policies and procedures should be developed to address which of the following?

Accepted Answer

The high-risk areas identified through the organization's specific risk assessment process.

Answer

An effective compliance program's policies and procedures must be tailored to the organization. This involves conducting a risk assessment to identify specific areas of vulnerability and high risk (e.g., billing, physician relationships, data privacy) and then developing policies and procedures to mitigate those identified risks.

Question 5

Which of the following is a key requirement for the ongoing management of compliance policies and procedures?

Accepted Answer

A system for annual review and updates to reflect changes in laws, regulations, and business operations.

Answer

Compliance policies and procedures are not static documents. An essential component of an effective compliance program is to have a system in place for their periodic (at least annual) review and update. This ensures they remain current with changing laws, regulations, and the organization's own operational realities.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Standards, Policies, and Procedures Questions and Answers