Auditing and Monitoring Flashcards
7 cards from real CHC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Auditing and Monitoring flashcards as text
In a stratified sampling approach for a compliance audit, what is the main advantage over simple random sampling?
Answer: It ensures proportional representation of distinct subgroups within the population
Stratified sampling divides the population into subgroups (strata) and samples from each, ensuring all relevant categories are represented in the audit.
What is 'extrapolation' in the context of a Medicare compliance audit?
Answer: Projecting the findings from a sample to estimate the error across the entire claim population
Extrapolation uses the error rate found in the sample to estimate the total overpayment or error amount across the full billing population.
Which element is NOT typically included in a formal audit report?
Answer: Personal opinions of individual staff members
Formal audit reports are objective documents; they include scope, methodology, findings, and recommendations, but not personal opinions of staff.
A healthcare organization's compliance monitoring program flags an unusually high rate of modifier 25 usage. What is the BEST next step?
Answer: Conduct a focused audit to determine if the modifier is being used appropriately
A focused audit investigates the specific flagged issue to determine root cause and whether the modifier is being appropriately applied before taking further action.
What role does a 'work plan' serve in an OIG compliance context for healthcare organizations?
Answer: It is the annual list of OIG audit and enforcement priorities used to guide internal compliance focus
The OIG Work Plan identifies the areas the OIG plans to review, helping healthcare organizations prioritize their own internal auditing and monitoring efforts.
Which of the following BEST describes 'continuous monitoring' in a compliance program?
Answer: Automated, real-time or near-real-time oversight of transactions and processes for anomalies
Continuous monitoring uses automated tools to provide ongoing, real-time oversight of processes and transactions, flagging anomalies as they occur.
Under a Corporate Integrity Agreement (CIA), what type of auditing is typically required of the organization?
Answer: Independent Review Organization (IRO) audits of claims and arrangements
CIAs typically require the organization to engage an Independent Review Organization (IRO) to conduct objective audits of claims, arrangements, or other specified areas.