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Compliance
medical
| Question | Answer |
|---|---|
| The government has a zero-tolerance policy toward fraud and abuse and will use extensive statutory authorities to reduce fraud in Medicare and other federally funded health care programs. t/f | True |
| Compliance programs should prohibit the employment of individuals who have been convicted of a criminal offense related to health care t/f | True |
| The creation of compliance program guidances is a major initiative of the __________. | Office of Inspector General |
| The OIG believes that a health care provider can use __________ controls to more efficiently monitor adherence to applicable statutes, regulations and program requirements. | internal |
| There are ___ components of an effective compliance program as set forth by the DHHS. | 7 |
| Conducting internal monitoring and _______ through the performance of periodic________ | auditing, audits |
| Implementing compliance and __________ standards through the development of written standards and _________. | practice, procedures |
| Designating a _________ officier or contact(s) to monitor compliance efforts and ________ practice standards. | compliance, enforce |
| Responding appropriately to detected ________ through the _______________ of allegations and the ___________ of_____________ to appropriate government entities. | violations, investigation, disclosure, incidents |
| Developing open lines of _________, such as discussions at staff meetings regarding how to avoid ___________ or _____________ conduct and community bulletin boards, to keep practice employees _____ regarding compliance activities. | Communication, erroneous, fraudulent, updated |
| Erroneous claims are done with actual knowledge in an attempt to defraud. t/f | False |
| If the physician/practice submits an erroneous claim, the physician/practice does have a duty to correct the error upon finding it. t/f | True |
| Innocent billing errors are those erroneous mistakes or errors and are not subject to criminal, civil or administrative penalties. t/f | True |
| Erroneous claims are _______ billing errors or mistakes. | innocent |
| Fradulent claims are done with actual knowledge and intent to _______ or with _______ disregard of 'deliberate'_________ of the _________. | defraud, reckless, ignorance, law |
| The government's primary enforcement tool that covers offenses that are committed with actual knowledge of the falsity of the claim, reckless disregard, or deliberate ignorance of the falsity of a claim is? | The False Claims Act |
| What are the two (2) types of reviews that can be performed as part of an ongoing evaluation for a successful complaince program? | Standards and Procedures Review Claims Submission audit |
| At least how frequently, after the baseline audit, is it generally recommended to perform audits? | one year |
| Physician practices do not have to provide separate education and training programs for the compliance and coding and billing training. All in-service training and continuing education can integrate compliance issues. t/f | True |
| Setting up compliance educational objectives should include: | determining who needs billing, coding and compliance training type of training that best suits the practice's needs when and how often education and training is needed |
| CERT | Comprehensive Error Rate Testing |
| What does CERT do? | measures improper payments in the medicare fee-for-service program |
| RAC | Recovery Audit Contractor |
| What does an RAC do | Identifies overpayment and underpayments in approximately 1/4 of the country, four regions. |
| CIA | corporate integrity agreements |
| WHat is the typical term length of a CIA | 5 years |
| What does a CIA address | attempt to accommodate and recognize compliance and address conduct issues. Seeks integrtiy of the federal health care program claims submitted by provider. |
| OCE | outpatient code editor |
| What does an OCE do | Edit data to identify errors and return a series of edit flags, Assign an amulatory payment classification number and an ambulatory Surgican center payment group |
| NCCI | National correct coding initiative |
| What does NCCI do | determines the extent to which medicare pays for services. |
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