Medicare cert - Study guides, Class notes & Summaries

What are the roles of physician advisor? - Regulatory oversight, cost containment, Medicare audits and denials, commercial insurance denials, length of stay management, clinical documentation improvement, and ICD-10 implementation. Done with concurrent reviews, daily MDR rounds, patient quality and safety initiatives, compliance, coding, CDI and physician education. PSROs- Professional standards review organizations - Created to review the quality, quantity, and cost of hospital care provided...

Comprehensive error rate testing CERT - Answer randomly selects a statistically-valid sample of Medicare FFS claims and reviews those claims and related medical records for compliance with Medicare coverage, payment, coding, and billing rules. Used to ID high- risk areas. Refers errors to MAC. More importantly, used for focused reviews. Payment Error Rate Measurement (PERM) program - Answer measures improper payments in the Medicaid program and the State Children's Health Insurance Program...

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

2023 Wellcare Medicare Certification Test Grand Canyon University

UHC MEDICARE CERTIFICATION EXAM (2024/2025) | ACTUAL QUESTIONS AND ANSWERS LATEST UPDATED 2024/2025 (GRADED A+)

DEVOTED MEDICARE CERTIFICATION 2025 EXAM QUESTIONS WITH CORRECT ANSWERS

Long term care hospitals must meet requirements for _____________ and have an agreement with ____________ in order to receive payments correct answers Acute care hospitals, Medicare The ___________ established the Common Clinical Data Set correct answers "ONC" Office of the National Coordinator Documentation that supports that skilled services are medically reasonable & necessary correct answers Medical Necessity Medicare Quality indicators are criteria that, if present in a patients ...

Medicare Certification Questions and Answers (True/False) 2023 T/F: When Medicare began in July 1, 1966, it was the primary payer for all beneficiaries except for those who had benefits from Large Group Health Plans (LGHPs). - False T/F: For diagnostic tests provided to Part A beneficiaries that are split into technical component and a professional component, both components are subject to Skilled Nursing Facility Consolidated Billing. - False T/F: A physician is an example of a provide...

CPMA Chapter 1 Exam Prep With 100% Correct Answers 12.1% - Correct Answer-# of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - Correct Answer-Fee-For-Service Prepayment Review - Correct Answer-Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - Correct Answer-Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicatin...