Cms fraud - 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...

Does Medicare pay for all tests ordered by Providers? - No, they need to determine if it's covered and medically necessary. For larger physician practices, how often does the OIG suggest reporting compliance activities to the board of directors? - Regularly According to the OIG, medically unnecessary services can be billed to Medicare for what purpose? - To receive a denial so a claim can be submitted to a secondary payer. Which component of the OIG has a duty of operating the OIG hotline...

HCCA CHC Exam Prep | 750+ Questions and Verified Answers| 2023/ 2024 Q: True of False: A self-audit is an examination or inspection for providers in reducing non-compliance. Self-audits can lower chances of an external audit and create a robust culture of compliance Answer: True Source: CHC Exam Secrets Study Guide Q: CMS released areas of high-risk fraud, some of those include: A. Sudden changes in billing and billing inappropriate specialties B. Billing of inappropriate d...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training EXAM 50+ QUESTIONS AND VERIFIED CORRECT ANSWERS 2023. AHIP TRAINING Medicare Fraud, Waste, and Abuse Training 1. Medicare plan means: A MA plan, MA-PD plan or PDP 2. Subcontractor means: **An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as ...

AEtna Sample Exam Questions with Answers Latest Grade A+ 2023/2024. Broker Services - Reports What report(s) are available on Aetna Producer World? a. Your Medicare book of business b. Monthly Commission Report (Two years of monthly data is available) c. License reports d. A and B e. All of the above - correct answer E. all of the above Ready To Sell - Agent RTS Requirements You will need to successfully complete which requirements to be Ready to Sell (RTS) with Aetna Medicare? a. Pass...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...

CMA NHA Practice Exams 1, 2 & 3 Questions and Answers 100% Pass You are drawing on a patient who becomes dizzy, sweaty, and flushed. What are they experiencing? syncope What is the best position to place a patient in if they are experiencing critically low blood pressure? trendlenburg When should a medical assistant verify a new patient's insurance information? When the appointment is scheduled How would a medical assistant handle an irate or angry patient about a bill they had received? Li...

Medicare Fraud, Waste, & Abuse (2022/2023) (Certified Answers) 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? a.Do what your immediate supervisor asked you to do and adjust or add risk diagnosis co...

CMS Fraud Definition - Answer- Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - Answer- An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - Answer- Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a higher payment amount, billing a M...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...