Health care fraud - Study guides, Class notes & Summaries

CPH Exam Practice Test Bank Prep_ Answered_2022. Many people do not attempt to decrease unhealthy behaviors such as overeating or smoking because they lack the confidence that they can successfully change. This is an example of: (A) Perceived susceptibility (B) Perceived severity (C) Perceived self-efficacy (D) Perceived response efficacy The construct of normative beliefs is from which model/theory? (A) Transtheoretical model (B) Theory of reasoned action/planned behavior (C) So...

H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer-C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the...

CPCO CERTIFICATION EXAM 70+ QUESTIONS AND ANSWERS 1. 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?

1. Principles are a. laws and regulations that guide behavior in the world of business. b. mores, values, and customs that guide behavior in general. c. specific and pervasive boundaries for behavior that are universal and absolute. d. the obligations businesses assume to maximize their positive impact and minimize their negative impact on stakeholders. e. the mores, values, and customs that parents teach their children. ANSWER: POINTS: DIFFICULTY: REFERENCES: LEARNING OBJECTIVES: NATIO...

CPCO CERTIFICATION EXAM 2024 WITH 100% CORRECT ANSWERS C. Health Care Fraud and Abuse Control Program (HCFAC) - correct 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 ...

Reimbursement Methodologies Questions and Answers 100% Verified What is the difference between direct and indirect reimbursement methods? Direct reimbursement involves payments made directly from the payer to the provider, while indirect reimbursement typically involves patients paying upfront and then seeking reimbursement from their insurance. How does case management impact healthcare reimbursement? Case management focuses on coordinating patient care to improve health outcomes...

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 ...

If a medical device malfunctions, the Occupational Safety and Health Administration (OSHA) requires the administrator to report the incident to the: 2. manufacturing producer 2 Emergency exits must have which of the following components? 1. Exit access (lit corridor), exit door (locked from inside or outside), and exit discharge (access to street or public way) 2. Exit sign (must be lit), exit access (corridor), and exit (must be double doors) 3. Exit sign, exit access (lit corridor)...

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...

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...