Exam (elaborations)
AHIP other/16 QUESTIONS WITH COMPLETE SOLUTIONS
- Course
- Institution
AHIP other/16 QUESTIONS WITH COMPLETE SOLUTIONS
[Show more]
Seller
Follow
Victorious23
Reviews received
Content preview
AHIP other/16 QUESTIONS WITH COMPLETESOLUTIONS
Which of the following requires intent to obtain payment and the knowledge
that the actions are wrong? - -Fraud
-Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)? - -Deportation
-A person comes to your pharmacy to drop off a prescription for a
beneficiary who is a "regular" customer. The prescription is for a controlled
substance with a quantity of 160. This beneficiary normally receives a
quantity of 60, not 160. You review the prescription and have concerns about
possible forgery. What is your next step? - -Call the prescriber to verify the
quantity
-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
verify, through a certain process, that the data is accurate. Your immediate
supervisor tells you to ignore the Sponsor's process and to adjust/add risk
diagnosis codes for certain individuals. What should you do? - -Report the
incident to the compliance department (via compliance hotline or other
mechanism
-You are in charge of payment of claims submitted by providers. You notice
a certain diagnostic provider ("Doe Diagnostics") requested a substantial
payment for a large number of members. Many of these claims are for a
certain procedure. You review the same type of procedure for other
diagnostic providers and realize that Doe Diagnostics' claims far exceed any
other provider that you reviewed. What should you do? - -Consult with your
immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit (SIU), or other
mechanism)
-You are performing a regular inventory of the controlled substances in the
pharmacy. You discover a minor inventory discrepancy. What should you do?
- -Follow your pharmacy's procedures
-Compliance is the responsibility of the Compliance Officer, Compliance
Committee, and Upper Management only. - -False
-Ways to report a compliance issue include: - -All of the above
-What is the policy of non-retaliation? - -Protects employees who, in good
faith, report suspected non-compliance
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Victorious23. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $6.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
81531 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now