General Compliance Training
You Will Learn
General Compliance Training
After completing this module, you will be able to:
- Recognize how a compliance program operates
- Identify and explain each of the seven core elements of a compliance program required by the Centers for Medicare and Medicaid Services (CMS):
-Written polices, procedures, and standards of conduct
-Compliance officer, compliance committee, and high-level oversight
-Effective training and education
-Effective lines of communication
-Well publicized disciplinary standards
-Effective system for routine monitoring, auditing, and identifying compliance risks
-Procedures for prompt response to compliance issues - Recognize the importance of conducting yourself in an ethical and legal manner
- Gain an understanding of how your organization’s Standards of Conduct can be used to guide your behavior in specific situations
- Understand what is meant by non-compliance
- Identify non-compliance risk situations
- List four potential consequences of non-compliance including contract termination
- Understand how non-compliance adversely impacts everyone including healthcare beneficiaries
- Recognize how compliance program violations should be reported
- Understand what happens after non-compliance is detected including the need for both internal monitoring and audits
| Started on | Saturday, January 4, 2025, 6:45 PM |
|---|---|
| State | Finished |
| Completed on | Saturday, January 4, 2025, 6:46 PM |
| Time taken | 1 min 12 secs |
| Points | 4.00/4.00 |
| Grade | 100.00 out of 100.00 |
| Feedback |
You have completed this Knowledge Check. |
Question 1
You work for a Sponsor. Last month, while reviewing a Centers for Medicare & Medicaid Services (CMS) monthly report, you identified multiple individuals not enrolled in the plan but for whom the Sponsor is paid. You spoke to your supervisor who said don't worry about it. This month, you identify the same enrollees on the report again. What should you do?
Question 2
You discover an unattended email address or fax machine in your office receiving beneficiary appeals requests. You suspect no one is processing the appeals. What should you do?
Question 3
You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do?
Question 4
A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR), submitted an application for processing and requested two things: 1) to back-date the enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary. What should you do?