Independent CHC Exam Study Guide for the Busy Professional

• ▸ Reading the CHC Content Domains as an Integrated System
• ▸ The 120-Question Format and How to Budget the Two-Hour Clock
• ▸ Building a Weekly Study Cadence Around a Demanding Job
• ▸ Choosing Your Study Path, Sequential Review, Domain Jumps, and Final-Week Drills

• ▸ Payers and Payment Models, Fee-for-Service, Managed Care, and Value-Based Payment
• ▸ Providers, Suppliers, and the Path of Claims and Reimbursement
• ▸ The Enforcement Landscape, OIG, DOJ, CMS, and State Agencies
• ▸ The False Claims Act, Elements, Penalties, and Qui Tam Provisions
• ▸ Stark Law and the Anti-Kickback Statute, Exceptions and Safe Harbors
• ▸ HIPAA, HITECH, and the Relationship Between Privacy and Compliance

• ▸ Publishing a Code of Conduct That Sets the Right Organizational Tone
• ▸ Drafting Written Policies With Clear Owners, Approvals, and Effective Dates
• ▸ Building a Policy Library With Version Control and Review Cycles
• ▸ Addressing High-Risk Areas in Written Standards, Billing, Coding, and Documentation
• ▸ Linking Policies to Board Oversight and Leadership Accountability

• ▸ Defining the Compliance Officer Role, Reporting Structure, and Independence
• ▸ Building the Compliance Committee and Board-Level Oversight
• ▸ Mapping Compliance Duties and Delegated Authorities Across the Organization
• ▸ Budgeting and Resourcing the Compliance Function

• ▸ Designing Initial Screening Processes for Applicants and New Hires
• ▸ Running Exclusion Checks, OIG LEIE, GSA SAM, and State Medicaid Lists
• ▸ Periodic Re-Screening and Evaluating Existing Employees
• ▸ Credentialing and Privileging Physicians Across the Organization
• ▸ Vendor and Third-Party Due Diligence, Screening Beyond Hiring

• ▸ Developing Compliance Training for Board Members, Executives, and Managers
• ▸ Tailoring Training by Role, Clinical Staff, Coders, Billers, and Administrators
• ▸ Choosing Training Methods, Live Sessions, Online Courses, and Refresher Content
• ▸ Measuring Comprehension Through Tests, Surveys, and Completion Tracking
• ▸ Managing the Annual Code of Conduct Certification Process

• ▸ Monitoring and Auditing as Distinct Control Activities
• ▸ Building a Risk-Based Audit Plan, What to Audit, How Often, and Why
• ▸ Establishing a Confidential Hotline and Multiple Internal Reporting Pathways
• ▸ Intake, Triage, and Referral of Compliance Reports
• ▸ Using Trends and Metrics From Reports to Improve Oversight

• ▸ Developing a Fair and Consistent Discipline Matrix
• ▸ Coordinating Discipline With Human Resources, Documentation and Legal Risk
• ▸ Applying Discipline in Common Scenarios, Billing Errors and Exclusion Violations
• ▸ Handling Discipline of Executives and Physicians Without Undermining Culture

• ▸ Deciding When to Launch an Investigation, Triggers and Thresholds
• ▸ Choosing Who Investigates, Compliance, HR, Internal Audit, or Outside Counsel
• ▸ Conducting Interviews and Collecting Evidence in a Defensible Way
• ▸ Writing Investigation Reports and Identifying Root Causes
• ▸ Remediation and Follow-Up, Measuring Whether Corrective Actions Hold

• ▸ Using Organizational Risk Assessments to Set Annual Priorities
• ▸ Drafting the Annual Compliance Work Plan, Objectives, Owners, and Timeframes
• ▸ Selecting and Tracking Compliance Program Metrics and Key Performance Indicators
• ▸ Sustaining the Program, Periodic Refreshers and Reporting to the Board

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