Fraud Abuse and Waste Tests Bundle Set

Fraud, abuse, and waste results in CORRECT ANSWER Overutilization of services ! Increased costs for payers ! Corruption of medical decision making ! Unfair competition ! Harm to patient Fraud CORRECT ANSWER intentional deception or misrepresentation that a person makes to gain a benefit to ...

ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on CORRECT ANSWER sex Section 1557 of the Affordable Care Act applies to CORRECT ANSWER c. all health programs and activities administered by or receiving federal financial assistance fr...

WHat's the problem with healthcare fraud and abuse? CORRECT ANSWER $765 billion per year has been lost due to fraud, abuse, and waste. ($75 billion is due to fraud) - overutilization of services and increased costs for payers - corrupts medical decision‐making -can lead to unfair competition i...

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. CORRECT ANSWER False Ways to report a compliance issue include: a. Telephone hotlines b. Report on the Sponsor's website c. In-person reporting to the compliance department/supervisor ...

what are your responsibilities(3) CORRECT ANSWER prevent, detect and report medicare non-compliance as well as possible fraud, waste and abuse 1. comply with all requirements 2. report 3. follow organizations code of conduct how do you prevent fraud CORRECT ANSWER be up to date on laws coordi...

intentional deception or intentional misrepresentation that a person makes to gain a benefit for which the person it not entitled CORRECT ANSWER fraud knowingly billing for services that were not furnished CORRECT ANSWER fraud knowingly altering claim forms to receive a higher payment amount C...

e CORRECT ANSWER Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above false CORRECT ANSWER Once a corrective a...

FRAUD, WASTE, AND ABUSE questions with correct answers

Patient Care Partnership CORRECT ANSWER Replaced 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...

Medicare plan means CORRECT ANSWER A MA plan, MA-PD plan or PDP Subcontractor means CORRECT ANSWER **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...

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...

Center for Medicare and Medicaid Services (CMS) CORRECT ANSWER The 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...

What is healthcare fraud? CORRECT ANSWER - 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...