Cpco prep stuvia - Study guides, Class notes & Summaries

Audit MICs can audit a Medicaid provider throughout his or her__________. - ANSWERCountry What type of software process identifies potential claim errors? - ANSWER? Data mining What does Medicare Part D cover? - ANSWERPrescription Drugs RACs perform what type of review(s) - ANSWERAutomated and complex What description below best describes ZPICs? - ANSWERZPICs are private companies contracted by CMS, used to conduct audits for Medicare and Medicaid overpayments What is the level 3...

Under EMTALA, all Medicare participating hospitals are required to provide at least a medical screening exam to a patient who comes to the emergency department ... -ANSWER regardless of the patient's insurance or ability to pay. Any laboratory performing testing on specimens derived from a human being for purposes of providing diagnosis, prevention, treatment, or assessment of health, regardless of whether they participate in Medicare, must: -ANSWER enroll In the CLIA program If I'm only...

Modifier 25 is used to allow additional payment for E/M services performed by a provider on the same day as a procedure, as long as ____________. -ANSWER The E/M services are significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure. To ensure that Medicare does not incorrectly reimburse the physician for the overhead portion of the payment if the service was performed in a facility setting it is important to have wh...

Why is the annual OIG Work Plan so important to Compliance Officers when they are developing their risk assessments? -ANSWER Because it shows results of previous year's audit findings and the current year's focus. A Compliance Officer does not have to be a lawyer, but your chances of implementing a successful compliance program increases when you are familiar with: -ANSWER Federal regulations Which office would a Compliance Officer contact if he or she had a question regarding discrimina...

Under EMTALA, all Medicare participating hospitals are required to provide at least a medical screening exam to a patient who comes to the emergency department ... -ANSWER regardless of the patient's insurance or ability to pay. Any laboratory performing testing on specimens derived from a human being for purposes of providing diagnosis, prevention, treatment, or assessment of health, regardless of whether they participate in Medicare, must: -ANSWER enroll In the CLIA program If I'm only...

Modifier 25 is used to allow additional payment for E/M services performed by a provider on the same day as a procedure, as long as ____________. -ANSWER The E/M services are significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure. To ensure that Medicare does not incorrectly reimburse the physician for the overhead portion of the payment if the service was performed in a facility setting it is important to have wh...

Audit MICs can audit a Medicaid provider throughout his or her__________. - ANSWERCountry What type of software process identifies potential claim errors? - ANSWER? Data mining What does Medicare Part D cover? - ANSWERPrescription Drugs RACs perform what type of review(s) - ANSWERAutomated and complex What description below best describes ZPICs? - ANSWERZPICs are private companies contracted by CMS, used to conduct audits for Medicare and Medicaid overpayments What is the level 3...

Why is the annual OIG Work Plan so important to Compliance Officers when they are developing their risk assessments? -ANSWER Because it shows results of previous year's audit findings and the current year's focus. A Compliance Officer does not have to be a lawyer, but your chances of implementing a successful compliance program increases when you are familiar with: -ANSWER Federal regulations Which office would a Compliance Officer contact if he or she had a question regarding discrimina...