Cpma chapter 6 - Study guides, Class notes & Summaries

Chapter 5 CPMA Exam: Contract-based Commercial Insurance Plans Questions and Answers Most common commercial insurance plans are - Answer-contract based That is, benefits arise primarily under a contract between the insurance company and the subscriber/patient Where the healthcare provider is in network, - Answer-the provider agrees to abide by certain rules in a separate contract.. The auditor must review the contract to determine the rules the provider is bound to follow For commercial...

CPMA Exam Chapter 5: Self-Disclosure Audits Study Guide The OIG Self-Disclosure Protocol (SDP) provides the - Answer-ability to self-disclose potential instances of fraud involving federal healthcare programs for which liability arises under the OIG's civil money penalty authorities The SDP (Self-Disclosure Protocol) is not for reporting of - Answer-potential or actual Stark (self-referral) violations; It is not a means to obtain an advisory opinion to determine if the suspect conduct ...

CPMA Exam - Chapter 5: Corrective action Plans Questions and Answers Except in the case of routine or annual compliance audits conducted on behalf of providers that do not have formal compliance programs or staff, - Answer-it is not usually the auditor's responsibility to develop a corrective action plan. In the case of audits associated with voluntary repayments or disclosures under the SDP (Self Disclosure Protocol) for potentially fraudulent conduct, - Answer-it usually falls to the ...