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CIC Exam Prep - Chapter 12 Compliance in the Facility
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CIC Exam Prep - Chapter 12 Compliance in the Facility
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CIC Exam Prep - Chapter 12 Compliance inthe Facility
_________ enforces the HIPAA Privacy Rule, Which protects the privacy Of individually
identifiable health information. - ANS-Office for Civil Rights (OCR)
___________ -A program launched by President Clinton that was designed to
demonstrate new partnerships and approaches in finding and stopping fraud and waste
in the Medicare and Medicaid program (federally funded). - ANS-Operation Restore
Trust
______________ requires any Medicare participating hospital that operates a hospital
emergency department to provide an appropriate medical screening examination to any
patient who requests such an examination. - ANS-EMTALA
_________________ is a Microsoft Access application allowing CMS to provide each
state with hospital-specific Medicare claims data statistics to identify areas with high
payment errors. These target area statistics serve as relative indicators of Payment
errors. - ANS-FATHOM: First-Look Analysis Tool for Hospital Outlier Monitoring
A _______________ conducts this second level appeal, which will consist of panel of
physicians or other healthcare Professionals conducting an independent review of
medical necessity issues. - ANS-qualified Independent Contractor (QIC)
A reconsideration must be filed within _____ days of receipt of the decision on
redetermination. - ANS-180
An _________ audit focuses on easily detectable payment errors. Given the ease of
detectability, the automated process requires no human review or medical records to
determine a finding of improper payment. - ANS-automated
CMS established the Comprehensive Error Rate Testing (CERT) program to monitor the
accuracy of claim payment in the Medicare __________(FFS) Program. - ANS-Fee for
service
Currently, the RACs are held to a _____ -year look back period for the identification of
improper payments. - ANS-3
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