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
What is the significance of the 'universe' in a compliance audit sampling context?
Answer: The total population of records or transactions from which the audit sample is drawn
The 'universe' refers to the entire population of records or claims subject to audit, from which a representative sample is selected.
Which of the following BEST represents a 'proactive' audit in a compliance program?
Answer: A scheduled review of high-risk billing areas before any specific issue is identified
Proactive audits are scheduled in advance as part of the annual audit work plan to identify and correct issues before they become problems or attract external scrutiny.
In the context of healthcare compliance, what does 'HEAT' stand for?
Answer: Health Care Fraud Prevention and Enforcement Action Team
HEAT (Health Care Fraud Prevention and Enforcement Action Team) is a joint DOJ and HHS initiative to prevent and combat Medicare and Medicaid fraud.
Which type of audit compares an organization's compliance performance to industry norms or peer organizations?
Answer: Benchmarking audit
Benchmarking audits compare an organization's results to external standards, peer organizations, or industry averages to identify areas of relative risk or performance gaps.
A compliance officer is reviewing the results of a claim audit and wants to report findings to leadership. Which metric BEST communicates the financial impact of identified errors?
Answer: The extrapolated overpayment amount based on the sample error rate
Extrapolating the sample error rate to the full population provides leadership with the estimated financial exposure, which is the most actionable compliance metric.
What is the primary purpose of an 'exit conference' at the conclusion of a compliance audit?
Answer: To communicate preliminary audit findings to management and allow for factual corrections before the final report
An exit conference allows auditors to share preliminary findings with management, giving the audited area an opportunity to provide additional context or correct factual errors before the report is finalized.
Which of the following is the MOST important characteristic of an effective healthcare compliance monitoring dashboard?
Answer: It should display real-time or near-real-time key risk indicators that allow for timely corrective action
An effective monitoring dashboard provides timely, actionable key risk indicators so compliance issues can be identified and addressed promptly, before they escalate.