Upon completion of this certification program, you should be able to:

• Recall the purpose of the CHC Test Prep Program and training.
• Describe best practices for maintaining a compliance plan and program.
• Identify the basic policies required for a Compliance Program.
• Identify the key individuals involved in preparing proper policies and procedures.
• Describe the process to approve key policies.
• Describe the importance of maintaining a code of conduct and key code components.
• Describe how to integrate mission, vision, values, and ethical principles within a code of conduct.
• Explain how to advocate for compliance resources that are scalable for the organization’s needs (e.g., financial resources and systems).
• Discuss how to report compliance program activity to the governance board/committee.
• Identify opportunities to coordinate operational aspects of a compliance program with the oversight committee.
• Recognize opportunities for collaboration with others to institute best compliance program.
• Define the scope of a compliance program consistent with current industry standards.
• Discuss how to assure that the compliance oversight committee’s goals and functions are defined.
• Explain how to evaluate the effectiveness of the compliance program on a periodic basis.
• Describe how to maintain knowledge of current regulatory changes and interpretation of laws.
• Explain how to coordinate organizational efforts to maintain a compliance program.
• Recognize the need for outside expertise.
• Identify means of defining the authority of the compliance officer at a high level.
• Describe how to assure the credibility and integrity of the compliance program.
• Identify how to verify the governing board understands its responsibility as it relates to the compliance program and culture.
• Describe how to assure that the role of risk partners in the compliance process has been defined (i.e., internal audit, risk management, legal, etc.)
• Define the responsibilities, purpose, and function for all compliance employees.
• Identify participation in the development of internal controls and systems to mitigate risk.
• Recognize incorporation of relevant aspects of regulatory agencies’ focus into compliance operations.
• Explain how to oversee the integration of compliance program into operations.
• Describe development of an annual compliance work plan.
• Define demonstration of independence and objectivity in all aspects of compliance program.
• Identify maintainenance of an independent reporting structure to the governing body (e.g., Board, Physician Practice Executive Committee).
• Recognize means of assuring that the role and scope of compliance officer are reflected in the job description and align with governing body expectations.
• Describe how to assure the organization has processes in place to identify and disclose conflicts of interest
• Assure inclusion of compliance obligations in all job descriptions
• Assure inclusion of compliance accountabilities as an element of performance evaluation
• Verify that the organization has an ongoing screening process for all employees and medical staff
• Assure exit interviews include compliance‑related questions
• Identify how to verify that government sanction lists for excluded individuals/entities (e.g., OIG, SAMS, SDN, SDGT)  are monitored
• Describe how to ensure due diligence is conducted periodically on third parties (e.g., consultants, vendors, acquisitions)
• Explain how to assure corrective action is taken based on background/sanction check findings
• Explain best practices for dissemination of regulatory guidance material.
• Describe methods of communication of compliance information throughout the organization.
• Describe how to communicate complex laws and regulations into a format employees can understand.
• Identify methods of workforce staff education on compliance policies.
• Describes mechanisms to evaluate employee understanding of compliance responsibilities.
• Describe how to promote a culture of compliance throughout the organization.
• Explain how to encourage employees to seek guidance and clarification when in doubt.
• Outline how to ensure staff participation in continuing education to maintain professional competence.
• Describe how to verify and track participation in ongoing compliance training programs.
• Assure general compliance training is conducted for all employees, governing body, physicians, vendors, and other agents.
• Assure risk‑specific training is conducted for targeted employees.
• Explain how to provide HR and management with training to recognize compliance risk associated with employee misconduct.
• Describe role‑specific training needed for governing body on their oversight responsibilities.
• Describe how to protect anonymity and confidentiality within legal and practical limits
• Discuss how to publicize the reporting system to all workforce members, vendors, and agents
• Define how to assure monitoring occurs to detect violations of laws and regulations
• Recognize how to conduct organizational risk assessments
• Identify how to develop work plan based on risk assessment
• Describe maintenance of reporting system(s) to enable employees to report any noncompliance (e.g., hotline)
• Discuss response to compliance concerns expressed by employees through internal reporting
• Recognize assurance of the existence of procedures for monitoring adherence to compliance policies and procedures
• Discuss how to conduct compliance audits.
• Define analysis of compliance audit results (e.g., track, trend, benchmark).
• Describe how to develop an annual compliance audit plan.
• Identify how to evaluate results of audits conducted by external entities.
• Recognize how to monitor so that retaliation has not occurred for reporting compliance concerns.
• Discuss how to employ auditing methodologies that are objective and independent.
• Describe how to determine sampling methodology consistent with circumstances.
• Define timely response as made to reported compliance concerns.
• Identify how to monitor management’s implementation of corrective action plans.
• Recognize how to provide timely feedback to management on compliance concerns based on audit results.
• Discuss recommendations for disciplinary action when noncompliance is substantiated.
• Identify discipline proportionate to violation.
• Describe how to verify that discipline is enforced consistently throughout all levels of the organization.
• Define monitoring for consistent disciplinary action.
• Recognize and recommend action for individuals and entities that have been excluded from government programs.
• Discuss how to verify that compliance‑related violations are addressed in disciplinary policies.
• Define coordination with management that timely disciplinary action is taken.
• Describe how to verify that disciplinary action is reported to regulatory body when required.
• Describe how to communicate suspected noncompliance through appropriate channels.
• Discuss development of corrective action plans in response to noncompliance.
• Define corrective action plans in response to noncompliance.
• Recognize how to cooperate with government inquiries and investigations.
• Identify how to investigate matters related to noncompliance in a fair, objective, and discrete manner.
• Describe participation in negotiation with regulatory agencies.
• Discuss how to assure that overpayments to payors are refunded in a timely manner.
• Define timely fulfillment of obligations to external parties.
• Describe collaboration with legal counsel regarding voluntary disclosures.
• Discuss coordination of investigations to preserve privileges, as applicable.
• Identify how to facilitate independent investigations when necessary.
• Define modification of corrective action plans.
• Recognize the need for subject matter experts.
• Describe how to assure compliance investigations are documented and records are maintained according to requirements.
• Discuss how to assure investigation personnel have the necessary skill sets.
• Identify institution of immediate measures as necessary to mitigate ongoing harm.