AHIP TRAINING Medicare Fraud, Waste, and Abuse Training bundled exams 2023 with 100% correct answers

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. correct answersFalse Ways to report a compliance issue include: correct answersall of the above What is the policy of non-retaliation? correct answersProtects employees who, in good fai...

Center for Medicare and Medicaid Services (CMS) correct answersThe Centers for Medicare & Medicaid Services, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medica...

Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis cod...

fraud correct answersintentional deception or misrepresentation that a person makes to gain a benefit to which they are not entitled. ex: false documentation. fraud results in... correct answersoverutilization of services increased costs to payors unfair competition harm to pt. g...

Medicare plan means correct answersA MA plan, MA-PD plan or PDP Subcontractor means correct answers**An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or or...

What are the causes for improper payment? correct answersUpcoding or incorrect coding Unnecessary services/medically unnecessary services Insufficient documentation ** (Usually it's excessive payment they're talking about; not underpayment) Fraud prevention system: how does it work (basic) c...

Pharmacies that provide services for federal health care programs are restricted from hiring pharmacists who have ___________. A. Been investigated for a violation of fraud, waste, and abuse regulations B. Not been certified to render Medicare, Medicaid, or DMEPOS services C. Committed a fel...

Operation Restore Trust (ORT) correct answersA program with partnerships within the federal government that fosters cooperation with states and ways of targeting, investigating, preventing, and stopping fraud in the Medicare and Medicaid programs Office of Inspector General (OIG) correct answersF...

Patient Care Partnership correct answersReplaced AHA patient's bill of rights during hospital state expect high quality of hospital care, clean safe environment, involvement in your care, protection of privacy, help when leaving hospital, help with billing claims Child Abuse definition correct...

I work in Radiology and have noticed a specific nurse performs comprehensive exams on patients without documenting them. Despite not documenting the exams, I know patients still get a bill for them What should I do? correct answersReport the situation to my leader or compliance leader; what we bill ...

Knowledge Check! Which of the following individuals is/are eligible for coverage under a Medicare plan? correct answersAll of the above Knowledge Check! True or False. The main job of Medicare strike force teams is to analyze data to detect fraud and ensure the integrity of healthcare. correct ...

What is healthcare fraud? correct answers- Illegal acts that are performed for financial gain - Knowingly and willingly committing these acts - Occur when an insurer is billed for services or medical devices that didn't occur or weren't needed. Who can be stakeholders in committing healthcare...