AAHAM - CCT EXAM Questions With Correct Answers

AABB - Answers American Association of Blood Banks; one of six CMS- approved accreditation organizations Abuse - Answers Improperly, and often unknowingly, violating regulations ALJ hearing - Answers The third level of Medicare appeal; the amount in controversy threshold for 2012 is $130 American Association of Blood Banks - Answers AABB; one of six CMS - approved accreditation organizations. American Osteopathic Association - Answers AOA; one of six CMS - approved accreditation organizations American Society of Histocompatibility and Immunogenetics - Answers ASHI; one of six CMS - approved accreditation organizations Anti-Kickback Statute - Answers The Act that makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration for referrals of items or services reimbursable by a federal healthcare program AOA - Answers American Osteopathic Association; one of six CMS - approved accreditation organizations Appeals Council Review - Answers The fourth level of appeal; which can be requested if the provider is not satisfied with the Administrative Law Judge's decision ASCA - Answers Administrative Simplification Compliance Act ASHI - Answers American Society of Histocompatibility and Immunogenetics; one of six CMS - approved accreditation organizations Automated review - Answers A RAC review using various types of analytics to identify improper payments; usually done without a human review of the medical records CAP - Answers College of American Pathologists; one of six CMS - approved accreditation organizations CERT - Answers Comprehensive Error Rate Testing program instituted by CMS to monitor and calculate the accuracy and error rates for all MAC's and to monitor the accuracy of Medicare payments to FIs, carriers, and DMERCs Certificate of Provider Performed Microscopy - Answers The CLIA certificate issued to a laboratory in which a physician, mid-level practitioner, or dentist performs specific microscopy procedures during the course of a patient's visit Certificate of Accreditation - Answers COA; the CLIA certificate issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS Certificate of Compliance - Answers COC; the CLIA certificate issued to a laboratory once the State Department of Health conducts an on-site survey/ inspection and determines that the laboratory is compliant with all applicable CLIA requirements Certificate of Registration - Answers The CLIA certificate issued to allow a laboratory to conduct nonwaived testing until the laboratory is surveyed to determine its compliance with the CLIA regulations Certificate of Waiver - Answers COW; the CLIA certificate issued to a laboratory that performs only waived tests -"simple laboratory examinations and procedures that have an insignificant risk of an erroneous result" CIA - Answers Corporate Integrity Agreement -the agreement that spells out the integrity measure required of a provider that has engaged in serious misconduct but is being allowed to continue participating in the healthcare programs, or Central Intelligence Agency CLIA - Answers Clinical Laboratory Improvement Amendment; the amendments that established quality standards for all laboratory testing CMP - Answers Civil Monetary Penalties CMS - Answers Centers for Medicare and Medicaid Services CMS Central Office Alert - Answers one of the five types of Fraud Alerts; prepared by ZPIC if a scheme is about to be publicized on a national level, the case involves patient abuse or a large dollar amount , or the issue involves politically sensitive testimony COA - Answers Certificate of Accreditation; the CLIA certificate issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS COC - Answers Certificate of Compliance; the CLIA certificate issued to a laboratory once the State Department of Health conducts an on-site survey /inspection and determines that the laboratory is compliant with all applicable CLIA requirements COLA - Answers Commission on Office Laboratory Accreditation; one of six CMS-approved accreditation organizations College of American Pathologists - Answers CAP; one of six CMS- approved accreditation organizations Commission on Office Laboratory Accreditation - Answers COLA; one of six CMS-approved accreditation organizations complex review - Answers a RAC review involving review of the medical record documentation; used where there is a high probability that the service is not covered or where no Medicare policy, Medicare article, or Medicare-sanctioned coding guideline exists Comprehensive Error Rate Testing - Answers CERT; a program instituted by CMS to monitor and calculate the accuracy and error rates for all MACs and to monitor the accuracy of Medicare payments to FIs, carriers and DMERCs COP - Answers Medicare Conditions of Participation Corporate Integrity Agreement - Answers the agreement that spells out integrity measures required of a provider that has engaged in serious misconduct but is being allowed to continue participating in the healthcare programs COW - Answers Certificate of Waiver; the CLIA certificate issued to a laboratory that performs only waived tests -"simple laboratory examinations and procedures that have an insignificant risk of an erroneous result" CPG - Answers Compliance Program Guidance demand letter - Answers document describing the rationale for a RAC determination and providing information in case an appeal is warranted DOJ - Answers Department of Justice EHR - Answers electronic health record EMC - Answers emergency medical condition Emergency Medical Treatment and Active Labor Act - Answers EMTALA; the Act that requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition; also known as the Federal Anit- Dumping Statute EMR - Answers electronic medical record EMTALA - Answers Emergency Medical Treatment and Active Labor Act EPHI - Answers electronic protected health information Fair Credit Billing Act - Answers an amendment to the Truth in Lending Act that protects consumers from inaccurate or unfair practices by issuers of open-ended credit Fair Credit Reporting Act - Answers Title VI of the Consumer Credit Protection Act that defines what information from consumer reports can be used, by whom, and when Fair Debt Collection Practices Act - Answers Title VIII of the Consumer Credit Protection Act that protects consumers from abusive, deceptive, and unfair collection practices False Claims Act - Answers the Act that helps recover billions of dollars stolen through fraud while also protecting whistleblowers from retaliation FDA - Answers Food and Drug Administration Federal Anti-Dumping Statute - Answers another name for EMTALA Fraud - Answers willingly and knowingly violating regulations full denial - Answers a RAC denial that occurs when the RAC determines that the service was not reasonable or necessary or that the service billed to CMS was not rendered GAO - Answers General Accounting Office; one of two government entities that produces reports every year that review and analyze aspects of Medicare payments GME - Answers Graduate Medical Education HCFAC - Answers Health Care Fraud and Abuse Control program established by HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs HCQIP - Answers Health Care Quality Improvement Program; a program that supports the mission of CMS to assure healthcare security for beneficiaries Health Care Fraud and Abuse Control - Answers HCFAC; a program established by HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs Health Care Quality Improvement Program - Answers HCQIP; a program that supports the mission of CMS to assure healthcare security for beneficiaries Health Information Technology for Economic and Clinical Health - Answers HITECH; an Act intended to accelerate the adoption of EHRs/EMRs among providers Health Insurance Portability and Accountability Act - Answers HIPAA; an Act passed in 1996 to improve portability and continuity of health insurance coverage; to combat waste, fraud and abuse in health insurance and healthcare delivery; to promote the use of medical savings accounts; to improve access to long-term care services and coverage; to simplify the administration of health insurance, etc.