Fraud abuse and waste - 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 contro...

2024 Anthem Administrative Guidelines Exam I completed all my training on Friday. When will I know I'm ready to sell? - ANS Only after receipt of the confirmation email should arrive on Monday. Training completed one day should be validated the following business day. What tool does BlueCross provide for you to submit notes taken during the meeting with a prospect? - ANS Cavulus If a member chooses to cancel or withdraw an enrollment application or terminate enrollment in a plan o...

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...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training | Latest Version 2024/2025 | Expert Verified | Ace the Test

Fraud, Waste, Abuse 2, Fraud Waste and Abuse, Preventing Fraud, Abuse & Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse 2024 AHIP, fraud, waste, and abuse prevention For 2024

HCCA – CHPC EXAM ACTUAL EXAM AND STUDY GUIDE LATEST COMPLETE 500+ QUESTIONS AND CORRECT DETAILED ANSWERS JUST RELEASED What is the purpose of HIPAA? - CORRECT ANSWERS • Protect PHI from unauthorized disclosure/use; • Prevent fraud, waste and abuse (via Administrative Simplification); • Make health insurance portable under ERISA; • Move health care onto a nationally standardized electronic billing platform Ref. More on HIPAA: HIPAA resides in which CFR section? - CORR...

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - False Ways to report a compliance issue include: a. Telephone hotlines b. Report on the Sponsor's website c. In-person reporting to the compliance department/supervisor d. All of the above - d. All of the above What is the policy of non-retaliation? a. Allows the Sponsor to discipline employees who violate the Code of Conduct b. Prohibits management and supervisor from harassi...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...

Fraud, Waste, Abuse - 2, Fraud Waste and Abuse, Preventing Fraud, Abuse & Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse 2024 AHIP, fraud, waste, and abuse prevention| 100% Correct e - Answer ️️ -Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above false - Answer ️️ -Once a corrective action plan is star...

e - Answer- Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above false - Answer- Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. : True False false - Answer- Any person who knowingly submits false claims to the Government is liable...