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 is an example of a compliance 'standard' as distinct from a 'policy' or 'procedure'?
Answer: The requirement that all PHI transmissions be encrypted to NIST standards
A standard defines a specific measurable requirement (e.g., encryption to NIST specifications) that policies and procedures must satisfy.
When a compliance policy conflicts with a state law that is MORE restrictive than federal law, the organization must:
Answer: Follow the more restrictive state law unless federal law explicitly preempts it
HIPAA and most federal healthcare laws set a floor, not a ceiling; organizations must comply with more restrictive state laws unless federal law explicitly preempts the state provision.
A compliance risk assessment should inform policy development by:
Answer: Identifying high-risk areas where robust policy controls are most needed
Risk assessments prioritize where policy controls are most needed, enabling the organization to allocate compliance resources to highest-risk operations.
Under the FCA's qui tam provisions, a relator (whistleblower) who files a successful lawsuit on behalf of the government may receive:
Answer: 15–30% of the government's recovery in the case
Qui tam relators are entitled to 15–30% of the government's recovery depending on whether the government intervenes in the case.
A healthcare organization's policy version control system should MOST importantly track:
Answer: Effective dates, revision history, approving authority, and next review date
Version control must capture effective dates, revision history, approvals, and scheduled reviews to demonstrate governance and support audit readiness.
Which of the following is the PRIMARY purpose of a healthcare organization's document retention policy?
Answer: To ensure records are retained for legally required periods and disposed of securely
Document retention policies ensure records are kept for legally mandated periods and destroyed securely afterward, balancing legal obligations with data minimization.
A compliance officer is updating a policy on medical necessity documentation. Which external source should be consulted FIRST to ensure regulatory alignment?
Answer: CMS Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)
LCDs and NCDs define Medicare's coverage and documentation criteria for medical necessity, making them the primary regulatory reference for billing-related documentation policies.