CHC Exam Flashcards

Q: How many questions are on the CHC exam?

The examination has 120 multiple-choice questions. CCB scores 100 of them; 20 are unidentified pretest questions. Candidates have two hours and should answer every item because scored and pretest questions are mixed together.

Q: What score is required to pass the CHC exam?

CCB uses the criterion-referenced Angoff method to determine the minimum passing score. It does not publish one fixed percentage or raw-score cutoff that candidates can treat as the universal passing mark.

Q: What is the current CHC blueprint?

The 100 scored questions are distributed as follows: Standards, Policies, and Procedures 11; Compliance Program Administration 19; Screening and Evaluation 6; Communication, Education, and Training 14; Monitoring, Auditing, and Internal Reporting Systems 22; Discipline for Non-compliance 8; Investigations and Remedial Measures 20.

Q: How were 50 flashcards allocated across the CHC blueprint?

The official counts were divided by two. The resulting whole-card allocation is 6, 9, 3, 7, 11, 4, and 10 cards respectively. Only the two half-card domains differ from their exact targets, by one percentage point each.

Q: What experience and education are needed for CHC eligibility?

The standard pathway requires one year in a full-time compliance position or 1,500 hours of direct compliance duties in the preceding two years, plus 20 approved CEUs within 12 months of testing, including at least 10 live CEUs. Completing a CCB-accredited university compliance certificate program satisfies the work-experience requirement for 24 months and the exam CEU requirement for 12 months after completion.

Q: Does the CHC exam require employer sponsorship or HCCA membership?

No. CCB permits qualifying members and nonmembers to apply. Eligibility depends on the published experience and CEU requirements, or the accredited-university student pathway, rather than employer sponsorship or association membership.

Q: What happens after a failed CHC attempt?

A candidate may reapply after receiving the score report if the required CEUs remain current. After two failed attempts within 180 days, the candidate must wait 180 days from the most recent exam date before applying again.

Q: How long is the CHC certification active?

The designation is active for two years. Renewal generally requires 40 CCB-approved CEUs earned during the renewal period, including at least 20 live CEUs, together with the renewal application and applicable fee.

Question 1

What is the code of conduct's function in a compliance program?

Accepted Answer

It states organization-wide ethical values and behavioral expectations. Detailed policies and procedures translate those expectations into requirements and operational steps for particular risks.

Question 2

How does a procedure differ from a compliance policy?

Accepted Answer

A policy states the rule, responsibility, or expected outcome. A procedure specifies who performs the required steps, when they occur, and what evidence is retained.

Question 3

What should trigger development or revision of a compliance policy?

Accepted Answer

Emerging laws, enforcement guidance, audit findings, incidents, new services, acquisitions, technology, or changed risk exposure should trigger review and documented revision through the organization's policy process.

Question 4

Why must Stark and Anti-Kickback analyses remain separate?

Accepted Answer

They have different elements and protections. A Stark exception does not automatically resolve Anti-Kickback risk, and an Anti-Kickback safe harbor does not establish Stark compliance.

Question 5

What does HIPAA's minimum-necessary standard generally require?

Accepted Answer

Use, request, or disclose only the PHI reasonably needed for the purpose. It generally does not apply to provider-to-provider treatment disclosures, disclosures to the individual, or authorized disclosures.

Question 6

What must a credible non-retaliation policy accomplish?

Accepted Answer

It must prohibit retribution for good-faith reporting or participation, identify reporting and escalation routes, and be supported by monitoring and consistent action when retaliation is suspected.

Question 7

What are OIG's seven compliance-program elements?

Accepted Answer

Written standards; leadership and oversight; training; effective communication and disclosure channels; incentives and consequences; risk assessment, auditing, and monitoring; and response to detected offenses with corrective action.

Question 8

What makes compliance resources scalable?

Accepted Answer

Staffing, expertise, technology, and budget should reflect the organization's size, services, geography, regulatory exposure, and risk profile—not a one-size-fits-all headcount.

Question 9

What should compliance reporting give the governing body?

Accepted Answer

Timely visibility into material risks, investigations, audit trends, corrective actions, resources, and program effectiveness so the board can exercise informed oversight and challenge management.

Question 10

How is the compliance officer's independence protected?

Accepted Answer

Provide sufficient authority, resources, direct access to the governing body, and an independent reporting route that prevents operational leaders from filtering or suppressing compliance concerns.

Question 11

What should a compliance oversight committee charter define?

Accepted Answer

Its purpose, membership, authority, meeting cadence, decision rights, escalation duties, documentation, and accountability for supporting and evaluating the compliance program.

Question 12

Why define the roles of legal, audit, HR, risk, and compliance?

Accepted Answer

Clear ownership reduces gaps, duplication, and conflicts. It also identifies who advises, investigates, decides, implements, validates, and reports without compromising independence or privilege.

Question 13

How should an organization define its compliance-program scope?

Accepted Answer

Map the program to its operations, payers, workforce, third parties, jurisdictions, and current industry risks while preserving organization-wide accountability for compliance.

Question 14

What distinguishes program effectiveness from activity counts?

Accepted Answer

Activity counts show work performed; effectiveness evidence shows whether risks were prevented, detected, corrected, and kept from recurring, using outcomes, trends, testing, and stakeholder feedback.

Question 15

How should regulatory change become an operational control?

Accepted Answer

Assign an owner to assess applicability, revise policies and workflows, communicate and train affected groups, implement controls, and test whether the change works in practice.

Question 16

What makes a conflict-of-interest process effective?

Accepted Answer

It requires disclosure, review by an appropriate independent party, documented mitigation or recusal, and periodic updates when roles, relationships, or financial interests change.

Question 17

Where should individual compliance accountability appear during employment?

Accepted Answer

Embed it in job descriptions, onboarding, performance evaluations, and exit interviews so expectations, observed concerns, and accountability are addressed across the employment lifecycle.

Question 18

What are the key controls in sanctions screening and third-party due diligence?

Accepted Answer

Check applicable exclusion and sanctions sources, verify possible matches with identifiers, document resolution, address confirmed exclusions, and investigate ownership, reputation, qualifications, and conflicts before engagement.

Question 19

How do general and risk-specific compliance training differ?

Accepted Answer

General training establishes baseline duties for broad audiences. Risk-specific training teaches affected roles how to recognize and control the particular risks they encounter.

Question 20

How should a compliance professional translate a complex regulation?

Accepted Answer

Convert it into audience-specific decisions, responsibilities, examples, escalation points, and job aids without changing the rule's meaning or omitting important exceptions.

Question 21

What False Claims Act knowledge standard should training distinguish from mistake?

Accepted Answer

Civil FCA knowledge includes actual knowledge, deliberate ignorance, and reckless disregard. A compliance response should verify facts rather than assume every error is intentional fraud.

Question 22

How can training test understanding rather than attendance?

Accepted Answer

Use role-based scenarios, knowledge checks, observation, audit results, and follow-up testing. Completion records alone show participation, not whether behavior or decisions improved.

Question 23

What should compliance training records establish?

Accepted Answer

Document the learner, content, date, delivery method, instructor or source, completion, and assessment results so the organization can demonstrate coverage and follow up on gaps.

Question 24

What behaviors indicate a strong speak-up culture?

Accepted Answer

People know where to ask questions, report concerns without fear, receive timely feedback when appropriate, and see leaders respond consistently rather than rewarding silence.

Question 25

Why should employees have a guidance channel separate from allegations?

Accepted Answer

Questions can prevent violations before they occur. A visible route for clarification complements reporting channels and helps compliance identify confusing policies or recurring risk areas.

Question 26

A control owner watches claim edits each week, while compliance performs a scoped retrospective review. Which activity is monitoring, and which is auditing?

Accepted Answer

The recurring observation of claim edits is monitoring. The defined retrospective review is auditing: an objective examination against criteria with documented scope, methodology, findings, and follow-up.

Question 27

How should a risk assessment shape the compliance work plan?

Accepted Answer

Prioritize auditable activities according to likelihood, impact, detectability, regulatory attention, prior findings, and available controls; document why resources address the highest risks.

Question 28

Why is a risk register more useful than an unranked issue list?

Accepted Answer

It records risk owners, causes, controls, ratings, mitigation, deadlines, and status, enabling transparent prioritization and reassessment as evidence or operations change.

Question 29

What promise should an internal reporting channel avoid?

Accepted Answer

Do not promise absolute confidentiality. Explain that anonymity and confidentiality are protected within legal and practical limits and information is shared only as needed.

Question 30

What belongs in the initial triage of a compliance report?

Accepted Answer

Assess immediate safety or ongoing harm, conflicts, evidence-preservation needs, mandatory deadlines, privilege considerations, credibility indicators, and the appropriate owner and urgency.

Question 31

How can compliance monitor for retaliation after a report?

Accepted Answer

Track adverse actions, schedule follow-up with the reporter when feasible, review management decisions for consistency, preserve confidentiality, and escalate suspected retaliation promptly.

Question 32

What makes a compliance audit objective and independent?

Accepted Answer

Qualified reviewers apply defined criteria and disclose conflicts; people responsible for the activity should not control the scope, evidence, conclusions, or reporting of findings.

Question 33

How should an auditor choose a sampling method?

Accepted Answer

Match the sample to the objective, population, known risk, data quality, and intended inference. A targeted probe can identify issues but cannot automatically support statistical extrapolation.

Question 34

What can trend analysis reveal that one audit rate cannot?

Accepted Answer

Patterns across time, locations, providers, codes, or controls can identify recurrence, outliers, improvement, deterioration, and where deeper review or resources are warranted.

Question 35

What should compliance do with an external audit result?

Accepted Answer

Validate scope and findings, identify broader exposure, assign remediation, meet response obligations, inform governance, and incorporate lessons into risk assessment and future monitoring.

Question 36

When is a corrective action plan truly closed?

Accepted Answer

Not when tasks are merely marked complete. Closure requires evidence that actions were implemented, responsible owners accepted them, and follow-up testing shows the control is effective.

Question 37

What is the central fairness principle in compliance discipline?

Accepted Answer

Comparable conduct should receive consistent treatment across seniority, revenue, professional status, or department, subject to documented differences in facts and applicable policy.

Question 38

How should disciplinary action relate to a substantiated violation?

Accepted Answer

It should be timely, proportionate to the conduct and circumstances, consistent with policy and precedent, coordinated with appropriate functions, and documented.

Question 39

Why must discipline reach leaders and high performers?

Accepted Answer

Exempting influential people undermines accountability, weakens reporting culture, and signals that written standards are optional. Compliance expectations apply at every organizational level.

Question 40

What follows confirmation that a worker or vendor is excluded?

Accepted Answer

Stop impermissible participation, follow policy, assess affected services and claims, coordinate timely action, document decisions, and make any required payer or regulatory reports.

Question 41

What is the first control after credible noncompliance is reported?

Accepted Answer

Triage immediate harm and preserve relevant evidence while restricting access only as necessary. Avoid premature conclusions, broad disclosures, or changes that could destroy information.

Question 42

What should an investigation scope document define?

Accepted Answer

State the allegations, issues, period, entities, records, witnesses, investigator authority, reporting route, and known limitations; update the scope when evidence justifies expansion or narrowing.

Question 43

When should legal counsel be considered in an investigation?

Accepted Answer

When legal advice, privilege, government exposure, disclosure duties, litigation risk, or conflicts are material. Counsel's involvement does not automatically make every business fact privileged.

Question 44

What makes a compliance investigation fair, objective, and discreet?

Accepted Answer

Use conflict-free investigators, test exculpatory and inculpatory evidence, document methods, protect information on a need-to-know basis, and give conclusions only the certainty the evidence supports.

Question 45

When does an investigation need a subject-matter expert?

Accepted Answer

Use qualified expertise when the issue requires specialized clinical, coding, valuation, privacy, technical, statistical, or regulatory judgment beyond the investigation team's competence.

Question 46

Why can remediation begin before an investigation ends?

Accepted Answer

Immediate controls may be necessary to stop ongoing harm, unsafe conduct, improper billing, evidence loss, or privacy exposure while preserving an objective inquiry into causes and scope.

Question 47

What question does root-cause analysis answer after substantiation?

Accepted Answer

It asks why the control system allowed the conduct—not merely who erred—so remediation can address incentives, process design, training, oversight, technology, and accountability.

Question 48

What makes a corrective action plan actionable?

Accepted Answer

Each action has an accountable owner, deadline, required evidence, risk-reduction purpose, escalation path, and effectiveness test tied to the investigation's root causes.

Question 49

How should an organization choose a voluntary disclosure pathway?

Accepted Answer

With counsel, match the conduct and legal exposure to the appropriate agency protocol; preserve deadlines, quantify supported facts, avoid unsupported conclusions, and coordinate repayment obligations.

Question 50

What does effective cooperation with a government inquiry require?

Accepted Answer

Preserve records, follow lawful process, coordinate through designated counsel and leaders, provide accurate timely responses, avoid obstruction or speculation, and track commitments through closure.

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