Free HCCB CHC Practice Test
1. A health care facility's income statement is an example of a...
- Baseline audit.
- Retrospective audit.
- Concurrent audit.
- Snapshot audit.
2. Which piece of legislation mandates that companies with securities listed in the United States abide by generally accepted accounting practices?
- Foreign Corrupt Practices Act
- Emergency Medical Treatment and Active Labor Act
- False Claims Act
- Civil Monetary Penalties Law
3. Which type of audit is generally recommended for health care compliance programs?
- Concurrent audit
- Baseline audit
- Retrospective audit
- Snapshot audit
4. According to the Office of the Inspector General, which of the following would be the least helpful measure for improving outpatient services?
- Describe the hospital's post-submission testing process to a fiscal intermediary.
- Evaluate all possible bills for outpatient services provided at the hospital and within the applicable time period.
- Implement computer programs to identify outpatient services that are not billed separately from inpatient services.
- Establish a regular manual review of outpatient service claim billing.
5. Which case established that a corporate director may breach his or her fiduciary obligation by failing to faithfully institute a compliance and ethics program?
- Rush Prudential v. Moran (2002)
- Caremark International Derivative Litigation (1996)
- Washington State Medical Association v. Regence BlueShield (2007)
- Medical Association of Georgia v. BlueCross and BlueShield of Georgia (2000)
1. B: A health care facility's income statement is an example of a retrospective audit. A retrospective (or historical) audit is a complete evaluation of the records or policies of an organization. A baseline audit is also a comprehensive evaluation of records or policies, but is undertaken for the express purpose of establishing benchmarks against which future performance may be compared. A concurrent audit is a real-time evaluation of records or policies. The problems identified by a concurrent audit are addressed as they are discovered. A snapshot audit is a comprehensive picture of the organization at a particular time. A health care facility's balance sheet would be a better example of a snapshot audit.
2. A: The Foreign Corrupt Practices Act mandates that companies with securities listed in the United States abide by generally accepted accounting practices. The act, passed in 1977, also outlaws the practice of bribing foreign officials. The Emergency Medical Treatment and Active Labor Act requires hospitals to provide emergency services to anyone in need, regardless of age, ethnicity, religion, or ability to pay. The False Claims Act forbids individuals and companies from defrauding government programs. Most of the cases associated with the False Claims Act have to do with health care, the military, or other government spending programs. The Civil Monetary Penalties Law imposes harsh fines on organizations that present false claims, provide false information to a government agency on purpose, or misdirect funds intended for a beneficiary of a federal health care program.
3. A: Concurrent audits are generally recommended for health care compliance programs. In a concurrent audit, problems are identified and resolved as they emerge, whereas in a retrospective audit, a much broader look is taken at the entire organization. A snapshot audit is essentially the same thing as a retrospective audit, because it produces a broad baseline risk assessment. On occasion, a retrospective or snapshot audit can be useful, but in most cases the organization being audited is much too complex for these audits to be very effective. A baseline audit is a comprehensive evaluation of the organization's recordkeeping procedures and other protocols. Baseline audits produce benchmark standards for comparison during future inspections.
4. A: According to the Office of the Inspector General (OIG), describing the hospital's post-submission testing process to a fiscal intermediary would be the least helpful measure for improving outpatient services. However, this is not to say that discussing the post-submission testing process with a fiscal intermediary would be a bad idea. Indeed, the OIG recommends that facilities create and maintain a periodic post-submission random testing process to evaluate the accuracy of previous claims, and then coordinate this process with a fiscal intermediary. The hospital should also alert the fiscal intermediary or any other appropriate government fiscal agents about returns of overpayments for incorrectly submitted or paid claims. The most important recommendations of the OIG, however, are described in the other three answer choices. The hospital should evaluate any potential bills for outpatient services within the applicable time period. The hospital should also implement computer software to identify outpatient services that are not being billed separately from inpatient services. Finally, the hospital should establish a regular manual review of outpatient service claim billing.
5. B: The Caremark International Derivative Litigation, which occurred in 1996, established that a corporate director may breach his or her fiduciary obligation by failing to faithfully institute a compliance and ethics program. This case was based on a situation in which a health care provider failed to provide certain types of health care because of a self-imposed corporate integrity agreement. In Rush Prudential v. Moran (2002), the Supreme Court asserted that the Employee Retirement Income Security Act (ERISA) does not supersede state independent review provisions. In other words, patients who are denied insurance benefits by an HMO may have this decision reviewed by an independent physician. In Washington State Medical Association v. Regence BlueShield (2007), the court declared that managed care organizations must use objective criteria when measuring physician performance. In addition, programs for measuring physician performance must be subject to appeal. In Medical Association of Georgia v. BlueCross and BlueShield of Georgia (2000), the court required managed care organizations to tell physicians in advance how much they will be paid.
Last Updated: 04/18/2018