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

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

crimes against consumers (retail): false advertising correct answers unfair and deceptive commerce - (not false statements, but deceptive statements) two conflicting principles: - 1st amendment (speech) vs gov. regulation of commerce forms of false advertising correct answers 1) Palming-Off -imitation is the best form of flattery -ex: claiming to be another company 2) misrepresentation -false or misleading claims about products 3) product disparagement -false negativ...

AHFI Examination Prep Course with Certified Solutions HCF Investigator Assumptions *General knowledge of the Health care Delivery System *Health plan policy and procedures relative to the delivery of services *Able to identify Red Flags, behaviors & indicators of health care fraud schemes Know applicable federal & state laws related to health care fraud *Law enforcement & regulatory agencies that have oversight responsibilities for HCF *Local & regional investigative groups ...

according to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? complex closure identify the 2 digit modifier that may be reported to indicate a doctor performed the postoperative management of a patient, but ANOTHER doctor performed the surgical procedure: -55 according to the QHDDS, what is the definition of "other diagnoses"? "other diagnoses" is interpreted as additional conditions that affect patient care in terms of ...

1. How does big data influence risk management and insurance strategy? a) It improves underwriting accuracy b) It reduces claims processing time c) It enhances customer engagement d) All of the above - Answer-d) All of the above 2. What is one benefit of data analytics in claims management? a) Faster and more efficient claims settlement b) Personalized pricing for customers c) Market expansion opportunities d) Improved underwriting accuracy - Answer-a) Faster and more efficient claims s...

WGU D333 (Latest 2024 / 2025 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-related decision making....

Which of the following descriptions MOST accurately portrays emergency medical services (EMS)? Select one: A. A team of health care professionals who are responsible for providing emergency care and transportation to the sick and injured B. A system composed exclusively of emergency medical responders (EMRs) and emergency medical technicians (EMTs) who are responsible for providing care to sick and injured patients C. A team of paramedics and emergency physicians who are responsible for prov...

HCF Investigator Assumptions - *General knowledge of the Health care Delivery System *Health plan policy and procedures relative to the delivery of services *Able to identify Red Flags, behaviors & indicators of health care fraud schemes Know applicable federal & state laws related to health care fraud *Law enforcement & regulatory agencies that have oversight responsibilities for HCF *Local & regional investigative groups that have similar interests Fraud, by it's very nature, is decptiv...

WGU D220 LATEST UPDATE (2022/2023)American Recover and Reinvestment Act (ARRA) Authorized INCENTIVE PAYMENTS to specific types of hospitals and healthcare professionals for adopting and using interoperable Health Information Technology and EHR's. ARRA provides economic stimuli and incentives for the adoption of EHRs. Admission-Transfer-Discharge (ADT) System Classified under the hospitals' administrative info system. It's one of the foundational systems that allows operational activi...

MULTIPLE CHOICE QUESTIONS GUIDE CBT EXAMS FOR NMC 1. What is the role of the NMC? a) To represent or campaign on behalf of nurses and midwifes b) To regulate hospital or other healthcare settings in the UK c) To regulate health care assistance d) To regulate nurses and midwives in the UK to protect the public 2. What is the purpose of The NMC Code? a) It outlines specific tasks or clinical procedures b) It ascertains in detail a nurse's or mi...