Kickback 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 contr...

CALIFORNIA LAW EXAM OPTOMETRY REALWITH 100% CORRECT ANSWERS 2023 COMPLETE SOLUTIONS ALEADY GRADED A Any person holding a license shall notify the issuing board of any changes in mailing address within ____ days after change - Correct answer-30 days It is prohibited to dispense, prescribe of sell eyeglasses not made of shatter-resistant lenses or non-flammable frames to _______ - Correct answer-1. one eyed person 2. law enforcement officer 3. fireman 4. person < 18 years old *not...

Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - Prohibits offering, paying, soliciting or reviving anything of value to induce or reward referrals or generate Federal health care program business Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - Referrals from anyone Anti-Kickback Statute (42 US SS 1320a-7b (b) - Any items or services Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - Intent MUST be proven (knowing and willful) Anti-Kickback Statute (42 US SS ...

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 ...

CPMA Exam Questions And Answers All Verified CMS Fraud Definition - ANS Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - ANS An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - ANS Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to ...

"hold harmless clause" CORRECT ANSWER-* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: CORRECT ANSWER-* more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a CORRECT ANSWER-entity that processes nonsta...

California Law Exam Optometry Exam 2024 Questions and Answers (Graded A)California Law Exam Optometry Exam 2024 Questions and Answers (Graded A)California Law Exam Optometry Exam 2024 Questions and Answers (Graded A)California Law Exam Optometry Exam 2024 Questions and Answers (Graded A) Any person holding a license shall notify the issuing board of any changes in mailing address within ____ days after change - ANSWER-30 days It is prohibited to dispense, prescribe of sell eyeglasses not mad...

CPMA Exam Questions and Answers Latest Updated 2023 CMS Fraud Definition Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a ...

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

Who develops a solicitation? - The Government & The Buyer. Who prepares an offer? - The Government & The Buyer. During the post-award phase while the contract is being performed, who has responsibility for quality? - The Seller. Personal conflict of interest? - FAR part 3 Organizational conflict of interest? - FAR part 9 Openness for the contracting officer applies primarily to? - The Acquisition Team, Contractors, Offerors, The Contracting Team. You need to document a business...