CPMA Chapter 1, Top Questions and answers, 100% Accurate. Rated A+

CPMA Chapter 1, Top Questions and answers, 100% Accurate. Rated A+ Stark Law - -Physician Self Referral Law Prohibits a physician from making a referral to an entity with which they or their immediate family has a financial relationship if the referral is for the furnishing of designated health services RAT-STATS - -A statistical software that is a valuable analytical tool used by auditors Components of RAT-STATS that should be used to perform CIA Claims Review - -"Random Numbers" to draw random samples for both the Discovery Sample and the Full Sample "Variable Appraisaisals" to calculate the mean & standard deviation of the overpayment amount in the sample "Sample Size Estimator" to estimate the size of the full sample CIA Reportable Events - -1. A substantial overpayment 2. A potential violation of criminal, civil, or admistrative laws 3. Filing of a bankruptcy petition OIG Work Plan - -Released annually and identifies priority areas for OIG review/investigation which the agency believes are HHS' most vulnerable programs and activities. The goal is to improve HHS agency efficiency and effectiveness. CIA - -Coporate Integrity Agreement - an agreement between the OIG and a health care provider or other entity when serious misconduct (fraudulent or abusive type action) is discovered through an audit of self-disclosure. It is detailed and restrictive. Government can do this instead of excluding Typical term is 5 years OIG - -Office of Inspector General - Mission is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries of those programs. Regulates: Corporate Integrity Agreements, Compliance Guidelines, Safe Harbor Regulations, and False Claims Act OAS - -Office of Audit Services - Performs audits for HHS Sanctions - -Penalties that are devised to encourage compliance Providers, staff, billers/coders, managers, etc... may also be liable