Health care fraud statute - 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...

RECA Fundamentals Exam Questions and Answers Already Passed Which of the following is NOT a RECA educational resource for industry professionals? Spatial Information System (Spin 2) Which entity has the authority to amend the Real Estate Act Provincial Legislature Which of the following measures the change in a cost of a fixed basket of goods and services purchased by families over a period of time Consumer Price Index (CPI) Which of the following will occur to the supply of a good when ther...

WGU C426 Healthcare Values and Ethics Rated A+ Normative Ethics Attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right. Consequential Ethics Theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. - What will be the effects of each course of action? - Will they be positive or negative? - Who will benefit? - What will do the least harm? Utilitarian Ethics The conce...

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...

CHAA Study Guide Latest Version Graded A Accreditation Defined as "a self-assessment and external peer assessment process used by healthcare organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve." Examples include: TJC, Healthcare Accreditation Program, DNVGL helps organize patient safety efforts, improves risk management, provides education, provides professional advice, authority for Med...

HCA 340 Midterm Study Guide Test Correctly Answered. The reckless disregard for the safety of another is known as: a) nonfeasance b) malpractice c) misfeasance d) criminal negligence - CORRECT ANSWER d. criminal negligence Legal obligation that requires a person to conform to a specific standard of care to protect others: a) causation b) breach of duty c) duty to care d) standard of care - CORRECT ANSWER c. duty to care Physician submission of multiple bills for single offi...

Which of the following is NOT a RECA educational resource for industry professionals? - Answer- Spatial Information System (Spin 2) Which entity has the authority to amend the Real Estate Act - Answer- Provincial Legislature Which of the following measures the change in a cost of a fixed basket of goods and services purchased by families over a period of time - Answer- Consumer Price Index (CPI) Which of the following will occur to the supply of a good when there is a change in quantity...

12.1% # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS Fee-For-Service Prepayment Review Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review 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 Master01 | September, 2024/2025 | Latest update 1 | P a g e |...

NCCT REVIEW LAW AND ETHICS EXAM QUESTIONS AND ANSWERS 1. Which of the following activities is an example of abuse rather than fraud? A. upcoding B. misrepresenting the diagnosis C. inadvertent coding errors D. billing for services not rendered - Answer-inadvertent coding errors Rationale Abuse is an unintentional mistake. Fraud is an intentional misrepresentation for gain. Upcoding, misrepresenting the diagnosis, and billing for services not rendered are examples of fraud. Inadvertent ...

CHC (2023/ 2024) Exam V1 |150 Questions and Verified Answers| 100% Correct Q: This is a very comprehensive legislation that ensures access to health coverage for those who change jobs or are temporarily out of work. It also provides the mechanism for funding the Department of Justice and the FBI for health care fraud investigations Answer: Health Insurance Portability and Accountability (HIPAA) Q: How long is PHI protected after the person's death? Answer: 50 years ...