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AHIP other questions and answers rated A+ 2025/2026
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AHIP other questions and answers rated A+ 2025/2026
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AHIP otherWhich of the following calls for reason to reap price and the expertise that the moves are
incorrect? - ANSFraud
Which of the subsequent is NOT doubtlessly a penalty for violation of a regulation or
regulation prohibiting Fraud, Waste, and Abuse (FWA)? - ANSDeportation
A man or woman comes in your pharmacy to drop off a prescription for a beneficiary who is
a "normal" purchaser. The prescription is for a managed substance with a quantity of one
hundred sixty. This beneficiary typically receives a amount of 60, no longer one hundred
sixty. You evaluate the prescription and have worries approximately possible forgery. What is
your next step? - ANSCall the prescriber to confirm the quantity
Your process is to submit a threat analysis to the Centers for Medicare & Medicaid Services
(CMS) for the cause of charge. As part of this activity you confirm, thru a positive procedure,
that the data is correct. Your on the spot supervisor tells you to ignore the Sponsor's
procedure and to modify/add threat diagnosis codes for sure people. What must you do? -
ANSReport the incident to the compliance branch (thru compliance hotline or different
mechanism
You are in fee of fee of claims submitted by means of companies. You word a certain
diagnostic provider ("Doe Diagnostics") requested a big charge for a huge quantity of
individuals. Many of these claims are for a sure procedure. You assessment the equal type
of procedure for different diagnostic providers and realise that Doe Diagnostics' claims a
ways exceed another company that you reviewed. What have to you do? - ANSConsult
together with your instant manager for next steps or contact the compliance branch (through
compliance hotline, Special Investigations Unit (SIU), or different mechanism)
You are appearing a ordinary inventory of the managed materials in the pharmacy. You
discover a minor inventory discrepancy. What must you do? - ANSFollow your pharmacy's
approaches
Compliance is the duty of the Compliance Officer, Compliance Committee, and Upper
Management handiest. - ANSFalse
Ways to document a compliance trouble include: - ANSAll of the above
What is the coverage of non-retaliation? - ANSProtects employees who, in exact religion,
report suspected non-compliance
These are examples of issues that may be suggested to a Compliance Department:
suspected Fraud, Waste, and Abuse (FWA); capability health privacy violation, and unethical
behavior/worker misconduct. - ANSTrue
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