Fraud abuse Study guides, Class notes & Summaries

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 codes for certain individuals. What should you do? Report the incident to the compliance department (via compliance hotline or other mechanism) You are performing a regular inventory of the contr...

HCCA CHC Exam Prep | 750+ Questions and Verified Answers| 2023/ 2024 Q: True of False: A self-audit is an examination or inspection for providers in reducing non-compliance. Self-audits can lower chances of an external audit and create a robust culture of compliance Answer: True Source: CHC Exam Secrets Study Guide Q: CMS released areas of high-risk fraud, some of those include: A. Sudden changes in billing and billing inappropriate specialties B. Billing of inappropriate d...

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...

ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on - sex Section 1557 of the Affordable Care Act applies to - c. all health programs and activities administered by or receiving federal financial assistance from HHS. Correct Which Medicare programs are covered by ACA Section 1557? - a. Parts A, C, and D, but not B. Correct Under ACA Section 1557, prohibited actions involve - d. eligibility, claims, and marketing. Correct Under...

ISTM 210 Final (11-14, HTML, Portfolio Project) Questions and answers, Rated A+ Whose tagline is, "We are Anonymous. We are Legion. We do not forgive. We do not forget. Expect us." - -Anonymous What is extremely easy to breach? - -An unsecured computer What is the key aspect of an Intranet? - -privacy What kind of hardware does a firewall use? - -proxy server What keeps unauthorized Internet users out of private intranets? - -firewalls Standard security practices dictate a what? - -...

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...

AHIP Fraud Waste and Abuse Questions With Verified Answers Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - ANSWER Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance...

AHIP Fraud Waste and Abuse Questions With Verified Answers Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - ANSWER Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance...

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...

FITSP-MANAGER EXAM QUESTIONS AND ANSWERS this legislation requires Federal agencies to develop document and implement an agency wide information security program - Answer ️️ -Clinger-Cohen What are the six steps of the RMF - Answer ️️ -Categorize Select Implement Assess Authorize Monitor What is the term used to evaluate operational information systems against the RMF, to determine the security controls in place and the requirements to mitigate risk at a acceptable level? - An...