What is healthcare fraud - Study guides, Class notes & Summaries

WGU D333 (Latest 2023/ 2024 Update) Ethics in Technology Exam| Questions and Verified Answers| 100% Correct| Grade A Q: What is industrial espionage? Answer: Acquiring competitors' sensitive information for promotion decisions. Q: What is a benefit of open source code? Answer: Open source code allows many programmers to read, redistribute, and modify the code so that it improves. Q: What is clinical decision support (CDS)? Answer: Process and tools to enhance health-r...

Questions 1. What is the name of your state’s insurance commission? Name depends upon the state of the student’s residence. 2. What is the mission of your state’s insurance commission? Mission depends upon the insurance commission of the state of the student’s residence. 3. List three consumer-related topics on the insurance commission’s website. Additional topics depend upon the insurance commission of the state of the student’s residence. However, common topics include frau...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

CPCO EXAM REVIEW QUESTIONS AND ANSWERS, 100% ACCURATE. VERIFIED. The OIG consists of 6 departments: - -1.Immediate OIG — responsible for the overall fulfillment of the OIG's mission and for promoting effective management and quality of the agency's processes and products. 2.Office of Audit Services — performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance. 3.Office of Evaluation and Inspections — conducts national evaluations...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE Q: John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? Answer: John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. Q: In which of the...

When auditing operative notes, the auditor will expect to see documentation from all of the following except: - ANSWER Surgical assistants. According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), an outside auditor must sign which of the following agreements prior to reviewing and auditing any medical records? - ANSWER Business Associate Agreement When auditing an ENT practice, you discover the practice uses an EMR. Which of the following options would you loo...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...

bioethics correct answer: The study of ethics related to issues that arise in health care. ethics correct answer: sustained and intentional reflection on morality and the moral life with analysis, discontent, reasoning, and arguments moral rules or principles of behavior that should guide members of a profession or organization and make them deal honestly and fairly with each other and with their custom utilitarianism correct answer: 1 fundamental moral good-to maximize outcomes of ...

ADJUSTER PRO EXAM WITH REVISED ANSWERS (2023) Stu has a collection of rare comic books. He wants to purchase theft insurance for his collection, separate from his home and other property. What term most accurately describes the type of policy Stu would purchase? - CORRECT ANSWER-Monoline Policy Which of the following statements does NOT apply to the Standard Fire Policy? - CORRECT ANSWER-It automatically covers wind and vandalism. Which of the following refers to being restored to the ...