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Probability - ______ that an event will occur is the relative frequency with which that event can be expected to occur P - theoretical probability P' - empirical probability Sample Space - the set of all possible outcomes of an experiment Sample Points - the individual outcomes in a sample space Event - any subset of a sample space A Complement - the set of all sample points in the sample space that do not belong to A Compound Event - any event made up of two or mor...

Statistics - the science of collecting, organizing, analyzing, and interpreting data in order to make decisions Treatment - applied to a group called the treatment group Control group - receives no treatment Placebo - a harmless, fake treatment that is made to look like the real treatment Simulation - the use of a mathematical or physical model to reproduce the conditions of a situation or process Survey - an investigation of one or more characteristics of a population Co...

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Medical Review Program is performed by - Macs, ZPICs/PSCs, and SMRCs Claim Review contractors identify suspected improper billing through - Error rates produced by the CERT Program, vulnerabilities identified through the Recovery Audit Program, claim data analysis, and evaluation of other information (for example, complaints). Generally, claim review contractors focus Medical Review (MR) activities on identified - problem areas and Select appropriate action for the severity of the p...

In the NCCI edits, what does modifier indicator nine represent? A. A modifier is not allowed to bypass the NCCI edits B. A modifier may be used to bypass the edits if the documentation supports the modifier C. Modifiers are not applicable he edits, the NCCI edit is not in effect D. Only modifier 59 can be used to bypass the edit. - c. Modifiers are not applicable he edits, the NCCI edit is not in effect In Corporate Integrity Agreement (CIA) does the OIG specify the Independent Review O...

ALJ - Administrative law judge OIG - Office of Inspector General CIA - Corporate Integrity Agreement IRO - Independent Review Organization HHS - Health and Human Services LEIE - List of Excluded Individuals /Entities CMPL - Civil Monetary Penalties Law NIH - National Institute of Health SOAP - Subjective, Objective, Assessment, Plan You are performing an audit of e/m services for a FP office. In the encounter you read the physician ordered and reviewed a differe...

Medically Unlikely Edits - Define the maximum units of service that a provider would report, under most circumstances, for a single beneficiary, on a single date of service, for a specific HCPCS/CPT code Purpose of the medically unlikely edits - To help reduce the paid claims error rate for Medicare Part B claims Medicare Modernization Act - Required a 3-year Recovery Audit demonstration, which ran between 2005 and 2008; during the demonstration, Medicare employed Recovery Auditors to i...

Federal Anti-Kickback Law - Prohibits the knowing and willful solicitation, offer, payment, or receipt of any remuneration (broadly interpreted to encompass anything of value), whether direct or indirect, in cash or in like kind, to induce or in return for referring an individual, or purchasing or arranging for an item of service for which payment may be mad under the Medicare, Medicaid, or other government health program. Safe Harbor Provisions - Describes various payment and business prac...

The sources of retirement income typically referred to as the "three-legged stool of retirement income" are? - Social Security, pension income, and individual investments. Social Security, pension income, and individual investments are all important sources of retirement income. A client can best estimate his or her old age Social Security benefits by? - obtaining an estimate of future benefits directly from the Social Security Administration. The Social Security Administration is the b...

As the investment policy statement formulation moves to policy implementation, the - A) investment professional takes a leading role. An investor notices that technology stocks are in a strong bull market and wants to take advantage of it. Even though valuations are at record high levels, he buys a technology stock that a brokerage firm is recommending. Which one of the following is the investor demonstrating? - rationalization One change in a client's situation that would require an ad...