Health care fraud statute - Study guides, Class notes & Summaries

Abuse - An action that results in unnecessary costs to a federal healthcare program, directly or indirectly. Anti-kickback - Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan. Benefiiciary - An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines. Conditions of Participation (CoP) - Conditions that healthcare organizations must meet in order to participate with the plan or ...

AAPC Official CPC Certification Study Guide Notes "Hold harmless clause" - answer* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: - answer* more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a - answer...

COLORADO ACCIDENT AND HEALTH GENERAL STATE EXAM SIMULATOR|QUESTIONS|ANSWERS COLORADO ACCIDENT AND HEALTH GENERAL STATE EXAM SIMULATOR|QUESTIONS|ANSWERS Which of the following statements about Health Reimbursement Arrangements (HRA) is correct? - Accurate AnswerIf the employee paid for qualified medical expenses, the reimbursements may be tax free. Which parts of a health insurance policy are guaranteed to be true? - Accurate Answerwarranty What is usually excluded from medical exp...

AABB - Answers American Association of Blood Banks; one of six CMS- approved accreditation organizations Abuse - Answers Improperly, and often unknowingly, violating regulations ALJ hearing - Answers The third level of Medicare appeal; the amount in controversy threshold for 2012 is $130 American Association of Blood Banks - Answers AABB; one of six CMS - approved accreditation organizations. American Osteopathic Association - Answers AOA; one of six CMS - approved accreditation orga...

CPB ExamAbuse - correct answer An action that results in unnecessary costs to a federal healthcare program, directly or indirectly. Anti-kickback - correct answer Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan. Benefiiciary - correct answer An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines. Conditions of Participation (CoP) - correct answer Conditions that health...

12.1% - ANSWER # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - ANSWER Fee-For-Service Prepayment Review - ANSWER Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - ANSWER Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment. Underpayment - ANSWER A payment a provider recei...

"hold harmless clause" correct answers * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: correct answers * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a correct answers entity that processes non...

CMCA PRACTICE EXAM 136 Questions with Verified Answers The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a hospital or hospital owned physician practice as well as other health care facilities. When assessing this element what does this include? A. The patient's ability to read, method of learning and understanding. B. Any language or physical disabilities. C. Cultural beliefs. D. All the above - CORRECT ANSWER D. All the above Report cop...

AAPC Official CPC Certification Study Guide Notes"hold harmless clause" - correct answer * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: - correct answer * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing h...

AAPC Official CPC Certification Study Guide Notes "hold harmless clause" - Answer ️️ -* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: - Answer ️️ -* more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing h...