Coding Quiz #4- Hosp. Inpatient Chapter 8-9 Questions & Answers

Coding Quiz #4- Hosp. Inpatient Chapter 8-9 Questions & Answers What does RAC stand for? - ANS-Recovery Audit Contractors What is the RAC purpose? - ANS-eliminates Fraud and Abuse and recoup incorrect payments found by the RAC auditors. -Primary look for: Medical necessity, excessive/duplicate payments, and Medicare as secondary payer issues -The Tax Relief & Healthcare Act of 2006 mandated that RAC auditing be permanent. RAC and the government audit covering durable medical equipment Medicare Administrative Contractor (DME MAC) share the same jurisdiction for this government auditing What is fraudulent activity? - ANS-Means that the provider intentionally, or with reckless disregard for the truth, filed false healthcare claims. Result can be civil or criminal prosecution What is erroneous billing (not intentional and considered abuse)? - ANS-Viewed as innocent billing errors, but will still be penalized; in most cases, just return the overpayment Federal Civil False Claims Act - ANS-The legislation that provides framework for federal fraud and abuse penalties and investigations. Law provides that a claim of fraud can be made up to 10 years from the date of violation -You will frequently see the use of "knew or should have known" associated with determination of fraud and abuse claims outcomes (meaning is a rule is published it must be followed) Seven key elements from the OIG for compliance & fraud & abuse prevention - ANS--Policies, procedures, standards of conduct -Designate a chief Compliance Officer & appropriate committee -Provide effective training & education program -Develop effective communication & process for reporting compliance issues CONTINUES...