AONE CNML KR FINALS ACTUAL ANSWERS AND
QUESTIONS SET A+
✔✔Pay for Performance (P4P) - ✔✔a general term defining financial incentives for
hospitals to improve the quality oof care provided. Measures in 4 quality measures:
Performance, Outcomes, Patient Satisfaction, Structures and Technologies
✔✔Payment Bundling - ✔✔when all providers are reimbursed in one payment; bundled
payments for care improvement. Goal = improved care and reduce costs
✔✔Care Continuum / Patient Throughput - ✔✔Entire spectrum of healthcare services
may need throughout their lives from preventative care to end of life care
✔✔False Claims Act - ✔✔Financial Compliance Law: enacted to combat fraud in war
government. Filing clams for services to provided, misrepresenting expenses, upcoding,
failing to disclose information, unbundling procedures
✔✔Stark Law (Physician Self-Referral Law) - ✔✔Financial Compliance Law: prohibits
drs from referring patients to certain healthcare services if the patient is covered by
Medicaid or Medicare. Prevents conflicts of interest. Ensures medical decisions are
made based on needs not money
✔✔Anti-Kickback Statue (AKS) - ✔✔Financial Compliance Law: prohibits offering or
receiving anything of value to induce or reward a referral for services or products. Goal
= prevent healthcare decision from being made based on financial gain
✔✔Office of Inspector General (OIG) - ✔✔Financial Compliance Law: Provides
compliance guideline for healthcare organizations to avoid fraud and abuse
✔✔Conditions of Participations (CoPs) - ✔✔specific health and safety requirements that
healthcare orgs must adhere to for participation in Medicare and Medicaid. Patient
rights, quality assessment, medical records, infection prevention and control
QUESTIONS SET A+
✔✔Pay for Performance (P4P) - ✔✔a general term defining financial incentives for
hospitals to improve the quality oof care provided. Measures in 4 quality measures:
Performance, Outcomes, Patient Satisfaction, Structures and Technologies
✔✔Payment Bundling - ✔✔when all providers are reimbursed in one payment; bundled
payments for care improvement. Goal = improved care and reduce costs
✔✔Care Continuum / Patient Throughput - ✔✔Entire spectrum of healthcare services
may need throughout their lives from preventative care to end of life care
✔✔False Claims Act - ✔✔Financial Compliance Law: enacted to combat fraud in war
government. Filing clams for services to provided, misrepresenting expenses, upcoding,
failing to disclose information, unbundling procedures
✔✔Stark Law (Physician Self-Referral Law) - ✔✔Financial Compliance Law: prohibits
drs from referring patients to certain healthcare services if the patient is covered by
Medicaid or Medicare. Prevents conflicts of interest. Ensures medical decisions are
made based on needs not money
✔✔Anti-Kickback Statue (AKS) - ✔✔Financial Compliance Law: prohibits offering or
receiving anything of value to induce or reward a referral for services or products. Goal
= prevent healthcare decision from being made based on financial gain
✔✔Office of Inspector General (OIG) - ✔✔Financial Compliance Law: Provides
compliance guideline for healthcare organizations to avoid fraud and abuse
✔✔Conditions of Participations (CoPs) - ✔✔specific health and safety requirements that
healthcare orgs must adhere to for participation in Medicare and Medicaid. Patient
rights, quality assessment, medical records, infection prevention and control
