AHFI Examination Prep Course Exam Questions - And
Verified Answers (100% correct verified solutions)
Graded A+
,Case Investigation: Evidence - {✔✔100%answer✔✔}-The purpose of
evidence is that it provides proof of, or supports a conclusion of a given
occurrence
What is considered evidence? It can be a fact or a specific occurrence; A physical
item that documents an occurrence
The value or use of evidence: It is the basis on which allegations are supported or
refuted; legal judgments for guilt or innocence
Case investigation that involves medical record audit -
{✔✔100%answer✔✔}-How many records? (Sampling-[SVRS]; Who requests
the records? Obtain on site? Was there payment?)
PHI/HIPAA: Where do I get authorization? TPO (Third Party Organization)?
Reviewing the records: Will the review be conducted internally or externally;
What about extrapolation?
Case Investigation: Examples of Evidence in a HCF case -
{✔✔100%answer✔✔}-Generally, potential evidence will come from the
sources of information -- includes internal and external sources
Claim forms, envelopes, super bills, medical records, presecriptions, verbal
statements, written statements, emails, license and discipline, texts, social media,
contracts, LMNs, recorded messages, checks, EFT, bank statements, data analysis
,Case Investigation: Evidence - Obtaining records - {✔✔100%answer✔✔}-
Mail request (less adversarial, more room for "creative' writing")
On site: In my opinion, MUCH better option (less chance of altering or fabrication)
Unannounced or announced (consider when do you give the provider the list of
names for records)
Know what contracts and state regulations allow
Case investigation - evidence - what amount and volume to get -
{✔✔100%answer✔✔}-Should tie back to reliable sampling methodology
Your resources should also be considered --can you handle a large investigation?
Case Investigation - Evidence - copying records - {✔✔100%answer✔✔}-
Bring your own copier or scanner if possible
Who pays? Who copies?
Leave copies (if taking originals) or treat copies as originals (if leaving originals)
Provide copy of inventory log
Investigation - Medical Record Red-Flags - {✔✔100%answer✔✔}-Misspelled
medical terminology
, Similarity of patient/provider handwriting
Inconsistency between procedures and age/gender
Inconsistency between treatment and diagnosis
Alteration of dates, amounts or other information
Dates out of order
Case Investigation: Evidence: Chain of Custody Best Practices -
{✔✔100%answer✔✔}-Inventory the Evidence: What item was taken; where
the item was taken from; when the item was taken; from whom was the item
taken; who took the item; and the date/time.
Keep evidence clean and admissible: Business records exception (Make NO
unnecessary marks -- you can make working copies; remember when you got
them) -- claims, customer service, etc.
Altered (E.G. White out or sticky notes) If there is a sticky note on a sheet -- make
two copies: one copy with the sticky not in place, and a second copy without the
sticky note)
Best evidence rule
Verified Answers (100% correct verified solutions)
Graded A+
,Case Investigation: Evidence - {✔✔100%answer✔✔}-The purpose of
evidence is that it provides proof of, or supports a conclusion of a given
occurrence
What is considered evidence? It can be a fact or a specific occurrence; A physical
item that documents an occurrence
The value or use of evidence: It is the basis on which allegations are supported or
refuted; legal judgments for guilt or innocence
Case investigation that involves medical record audit -
{✔✔100%answer✔✔}-How many records? (Sampling-[SVRS]; Who requests
the records? Obtain on site? Was there payment?)
PHI/HIPAA: Where do I get authorization? TPO (Third Party Organization)?
Reviewing the records: Will the review be conducted internally or externally;
What about extrapolation?
Case Investigation: Examples of Evidence in a HCF case -
{✔✔100%answer✔✔}-Generally, potential evidence will come from the
sources of information -- includes internal and external sources
Claim forms, envelopes, super bills, medical records, presecriptions, verbal
statements, written statements, emails, license and discipline, texts, social media,
contracts, LMNs, recorded messages, checks, EFT, bank statements, data analysis
,Case Investigation: Evidence - Obtaining records - {✔✔100%answer✔✔}-
Mail request (less adversarial, more room for "creative' writing")
On site: In my opinion, MUCH better option (less chance of altering or fabrication)
Unannounced or announced (consider when do you give the provider the list of
names for records)
Know what contracts and state regulations allow
Case investigation - evidence - what amount and volume to get -
{✔✔100%answer✔✔}-Should tie back to reliable sampling methodology
Your resources should also be considered --can you handle a large investigation?
Case Investigation - Evidence - copying records - {✔✔100%answer✔✔}-
Bring your own copier or scanner if possible
Who pays? Who copies?
Leave copies (if taking originals) or treat copies as originals (if leaving originals)
Provide copy of inventory log
Investigation - Medical Record Red-Flags - {✔✔100%answer✔✔}-Misspelled
medical terminology
, Similarity of patient/provider handwriting
Inconsistency between procedures and age/gender
Inconsistency between treatment and diagnosis
Alteration of dates, amounts or other information
Dates out of order
Case Investigation: Evidence: Chain of Custody Best Practices -
{✔✔100%answer✔✔}-Inventory the Evidence: What item was taken; where
the item was taken from; when the item was taken; from whom was the item
taken; who took the item; and the date/time.
Keep evidence clean and admissible: Business records exception (Make NO
unnecessary marks -- you can make working copies; remember when you got
them) -- claims, customer service, etc.
Altered (E.G. White out or sticky notes) If there is a sticky note on a sheet -- make
two copies: one copy with the sticky not in place, and a second copy without the
sticky note)
Best evidence rule
