Standards, Policies, and Procedures 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 Standards, Policies, and Procedures flashcards as text
Which of the following BEST describes the purpose of a code of conduct in a healthcare compliance program?
Answer: To articulate the organization's ethical principles and behavioral expectations for all personnel
A code of conduct communicates the organization's core values and sets behavioral expectations as the ethical foundation of the compliance program.
Under the Stark Law, which of the following financial relationships between a physician and a hospital would require a written exception?
Answer: A physician who owns stock in the hospital and refers Medicare patients there
Stark Law prohibits physician self-referrals unless a specific exception applies; physician ownership with referrals to that entity requires careful structuring under an applicable exception.
A compliance officer discovers that a departmental procedure contradicts a newly updated organization-wide policy. The BEST course of action is to:
Answer: Escalate to department leadership and legal to align the procedure with the policy
Conflicting documents create compliance risk; the compliance officer should work with department leadership and legal counsel to reconcile the procedure with the governing policy.
The False Claims Act (FCA) imposes liability on healthcare organizations that submit claims that are:
Answer: Knowingly false or fraudulent to government payers
The FCA targets knowingly false, fraudulent, or recklessly disregarded claims submitted to federal healthcare programs.
Which document type provides the authoritative basis (the 'why') that all related procedures and work instructions should reference?
Answer: Policy
A policy establishes the organizational rule or principle that gives authority and rationale to the procedures and work instructions that implement it.
According to CMS Conditions of Participation, hospitals must have policies governing patient rights. Which of the following is a required patient right that must be reflected in those policies?
Answer: The right to receive care in a safe setting and to be free from abuse
CMS Conditions of Participation require hospitals to have policies ensuring patients receive care in a safe environment, free from abuse, neglect, and exploitation.
A healthcare organization's policy requires dual authorization for wire transfers over $100,000. This control is designed primarily to prevent:
Answer: Fraudulent financial transactions and embezzlement
Dual authorization controls on large financial transactions are a segregation-of-duties safeguard against internal fraud and embezzlement.