AHIP FWA Study/Test Prep
.Best describes Section 1557 - ANSWhich of the following statements best describes
Section 1557 of the Affordable Care Act (ACA)?
Answer: Section 1557 incorporates earlier civil rights protections in regard to race, color,
national origin, disability, age and sex.
ACA Section 1557 rules....disability - ANSACA Section 1557 rules for disability concern
Answer: policies and procedures, physical access, and communication.
Under ACA Section 1557....health premium - ANSUnder ACA Section 1557, a health plan
premium sold through a state exchange may, based on an individual's age and
Answer: charge higher premiums.
As a result....violations - ANSAs a result of violations of ACA Section 1557 nondiscrimination
rules,
Answer: a health plan may revoke an agent or broker's appointment with the health plan.
Which Medicare programs are covered.... - ANSWhich Medicare programs are covered by
ACA Section 1557 under the Biden Administration's Proposed Rule?
Answer: Parts A, C, and D, and as proposed Part B.
NOT - ANSWhich of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting fraud, waste, and abuse (FWA)?
Answer: Deportation
intent and knowledge - ANSWhich of the following requires intent to obtain payment and the
knowledge the actions are wrong?
Answer: Fraud
"Doe Diagnostics" - ANSYou are in charge of paying claims submitted by providers. You
notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for
a large patient group. Many of these claims are for a certain procedure. You review the same
type of procedure for other diagnostic providers and realize Doe Diagnostics' claims far
exceed any other provider you reviewed. What should you do?
Answer: Consult with your immediate supervisor for next steps or contact the compliance
department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
submit a risk report - ANSYour job is to submit a risk diagnosis to the Centers for Medicare &
Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process
to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's
process and to adjust or add risk diagnosis codes for certain individuals. What should you
do?
Answer: Report the incident to the compliance department (via compliance hotline or other
mechanism)
.Best describes Section 1557 - ANSWhich of the following statements best describes
Section 1557 of the Affordable Care Act (ACA)?
Answer: Section 1557 incorporates earlier civil rights protections in regard to race, color,
national origin, disability, age and sex.
ACA Section 1557 rules....disability - ANSACA Section 1557 rules for disability concern
Answer: policies and procedures, physical access, and communication.
Under ACA Section 1557....health premium - ANSUnder ACA Section 1557, a health plan
premium sold through a state exchange may, based on an individual's age and
Answer: charge higher premiums.
As a result....violations - ANSAs a result of violations of ACA Section 1557 nondiscrimination
rules,
Answer: a health plan may revoke an agent or broker's appointment with the health plan.
Which Medicare programs are covered.... - ANSWhich Medicare programs are covered by
ACA Section 1557 under the Biden Administration's Proposed Rule?
Answer: Parts A, C, and D, and as proposed Part B.
NOT - ANSWhich of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting fraud, waste, and abuse (FWA)?
Answer: Deportation
intent and knowledge - ANSWhich of the following requires intent to obtain payment and the
knowledge the actions are wrong?
Answer: Fraud
"Doe Diagnostics" - ANSYou are in charge of paying claims submitted by providers. You
notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for
a large patient group. Many of these claims are for a certain procedure. You review the same
type of procedure for other diagnostic providers and realize Doe Diagnostics' claims far
exceed any other provider you reviewed. What should you do?
Answer: Consult with your immediate supervisor for next steps or contact the compliance
department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
submit a risk report - ANSYour job is to submit a risk diagnosis to the Centers for Medicare &
Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process
to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's
process and to adjust or add risk diagnosis codes for certain individuals. What should you
do?
Answer: Report the incident to the compliance department (via compliance hotline or other
mechanism)
