Cpco stuvia - Study guides, Class notes & Summaries

Question 1 Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse? - Answer Health Care Fraud and Abuse Control Program (HCFAC) Question 2 According to the Federal Sentencing Guidelines, "To have an effective compliance and ethics program..., an organization shall exercise due diligence to...

C. Health Care Fraud and Abuse Control Program (HCFAC) -ANSWER Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse? A. Health Care Fraud Prevention and Enforcement Action Team (HEAT) B. Health Care Recovery and Affordable Care Act (HCRAC) C. Health Care Fraud and Abuse Control Program (H...

One of the most important elements of an effective compliance program is to have a compliance officer or committee who is__________. -ANSWER empowered If an employee, provider or anyone that deals with Federal or State healthcare dollars has intent to receive payment for services not legitimately rendered this is considered ______________? -ANSWER fraud Joan, as an employee of a healthcare organization, has _________to report erroneous conduct, without repercussions, so that it may be co...

compliance certification agreements (CCAs) require providers to certify they will continue to operate their existing compliance program for a fixed term. What is the typical term of a corporate integrity agreement (CIA)? -ANSWER three years The OIG has stated that an affective compliance plan can help create which of the following? -ANSWER customer loyalty, community support, and financial success The office for civil rights (OCR) has enforcement power for violations occurring as a result ...

Question 1 Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse? -ANSWER Health Care Fraud and Abuse Control Program (HCFAC) Question 2 According to the Federal Sentencing Guidelines, "To have an effective compliance and ethics program..., an organization shall exercise due diligence to ...

One of the most important elements of an effective compliance program is to have a compliance officer or committee who is__________. -ANSWER empowered If an employee, provider or anyone that deals with Federal or State healthcare dollars has intent to receive payment for services not legitimately rendered this is considered ______________? -ANSWER fraud Joan, as an employee of a healthcare organization, has _________to report erroneous conduct, without repercussions, so that it may be corr...

C. Health Care Fraud and Abuse Control Program (HCFAC) -ANSWER Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse? A. Health Care Fraud Prevention and Enforcement Action Team (HEAT) B. Health Care Recovery and Affordable Care Act (HCRAC) C. Health Care Fraud and Abuse Control Program (H...

Audit MICs can audit a Medicaid provider throughout his or her__________. - ANSWERCountry What type of software process identifies potential claim errors? - ANSWER? Data mining What does Medicare Part D cover? - ANSWERPrescription Drugs RACs perform what type of review(s) - ANSWERAutomated and complex What description below best describes ZPICs? - ANSWERZPICs are private companies contracted by CMS, used to conduct audits for Medicare and Medicaid overpayments What is the level 3...

Under EMTALA, all Medicare participating hospitals are required to provide at least a medical screening exam to a patient who comes to the emergency department ... -ANSWER regardless of the patient's insurance or ability to pay. Any laboratory performing testing on specimens derived from a human being for purposes of providing diagnosis, prevention, treatment, or assessment of health, regardless of whether they participate in Medicare, must: -ANSWER enroll In the CLIA program If I'm only...

Modifier 25 is used to allow additional payment for E/M services performed by a provider on the same day as a procedure, as long as ____________. -ANSWER The E/M services are significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure. To ensure that Medicare does not incorrectly reimburse the physician for the overhead portion of the payment if the service was performed in a facility setting it is important to have wh...