CMOM Certification Study Set Module
4 Questions and Answers
Medicare Incentive Reward Program (IRP) - Answer-established to pay an incentive
reward to individuals who provide information on Medicare fraud and abuse or other
sanctionable activities
Medicare Contract Statutory Obligations - Answer-Services must be furnished (1)
economically and only when and to the extent (2) medically necessary; of a (3) quality
that meets professionally recognized standards of health care; and (4) supported by
evidence
OIG - Answer-Office of the Inspector General
Office of the Inspector General (OIG) - Answer-A government agency established to
monitor and control misuse of federal funds via any government agency or program.
PRO - Answer-Peer Review Organizations
CERT - Answer-Comprehensive Error Rate Testing
Comprehensive Error Rate Testing (CERT) - Answer-program in place to ensure that
claims by providers are properly paid by carriers. To prevent, identify and stop errors
through auditing and provider education
Seven Steps to The OIG Compliance Program - Answer-1)Conducting Internal
Monitoring and Auditing
2)Implementing compliance and practice standards
3)Designating a compliance office or contact
4)Conducting appropriate training and education
5)Responding appropriately to detected offenses and developing corrective action
6)Developing open lines of communication
7)Enforcing disciplinary standards through well-publicized guidelines
RA - Answer-Recovery Audit Programs
Recovery Audit Programs (RAs) - Answer-Tasked with identifying both overpayments
and underpayments to healthcare providers
Stark Violations - Answer-physicians referring patient to services in which they have a
financial interest or in which a family member has a financial interest
, Automated Review - Answer-Used by RAs when there is 1)certainty that the item or
service is not covered or is incorrectly coded AND 2) a written Medicare policy exists
Complex Review - Answer-Used by RAs when there is a high probability (but not
certainty) that the service is not covered or where no Medicare policy exists
OSHA - Answer-Occupational Safety and Health Act
Primary Goals of OSHA - Answer-1) To reduce injuries, illness and death
2) To provide leadership and encouragement to employees and workers to help
recognize and realize the value of safety and health on the job
CSHO - Answer-Compliance Safety and Health Officers
Compliance Safety and Health Offices - Answer-the designated individuals from OSHA
who could inspect your facility for at least one of 5 reasons
Five Reasons for OSHA inspection - Answer-1)Employe complaints
2)Fatalities
3)Routine inspections for High Hazard
4)Catastrophes (3 or more hospitalized)
5)General inspections
Risk Analysis - Required Administrative SafeGuard - Answer-Conduct an accurate and
thorough assessment of the potential risks and vulnerabilities to the confidentiality,
integrity, and availability of electronic PHI held by a covered entity.
Risk Management - Required Administrative Safeguard - Answer-Implement security
measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate
level to comply with the standard.
Sanction Policy -Required Administrative Safeguard - Answer-Apply appropriate
sanctions against workforce members who fail to comply with the security policies and
procedures of a covered entity.
Information system activity review -Required Administrative Safeguard - Answer-
implement procedures to regularly review records of information system activity, such
as audit logs, access reports, and security incident tracking reports.
Assigned security responsibility -Required Administrative Safeguard - Answer-Identify
the security official who is responsible for the development and implementation of the
policies and procedures required by this subpart for the entity.
Workforce Security -Required Administrative Safeguard - Answer-Implement policies
and procedures to ensure that all members of the workforce have the appropriate
4 Questions and Answers
Medicare Incentive Reward Program (IRP) - Answer-established to pay an incentive
reward to individuals who provide information on Medicare fraud and abuse or other
sanctionable activities
Medicare Contract Statutory Obligations - Answer-Services must be furnished (1)
economically and only when and to the extent (2) medically necessary; of a (3) quality
that meets professionally recognized standards of health care; and (4) supported by
evidence
OIG - Answer-Office of the Inspector General
Office of the Inspector General (OIG) - Answer-A government agency established to
monitor and control misuse of federal funds via any government agency or program.
PRO - Answer-Peer Review Organizations
CERT - Answer-Comprehensive Error Rate Testing
Comprehensive Error Rate Testing (CERT) - Answer-program in place to ensure that
claims by providers are properly paid by carriers. To prevent, identify and stop errors
through auditing and provider education
Seven Steps to The OIG Compliance Program - Answer-1)Conducting Internal
Monitoring and Auditing
2)Implementing compliance and practice standards
3)Designating a compliance office or contact
4)Conducting appropriate training and education
5)Responding appropriately to detected offenses and developing corrective action
6)Developing open lines of communication
7)Enforcing disciplinary standards through well-publicized guidelines
RA - Answer-Recovery Audit Programs
Recovery Audit Programs (RAs) - Answer-Tasked with identifying both overpayments
and underpayments to healthcare providers
Stark Violations - Answer-physicians referring patient to services in which they have a
financial interest or in which a family member has a financial interest
, Automated Review - Answer-Used by RAs when there is 1)certainty that the item or
service is not covered or is incorrectly coded AND 2) a written Medicare policy exists
Complex Review - Answer-Used by RAs when there is a high probability (but not
certainty) that the service is not covered or where no Medicare policy exists
OSHA - Answer-Occupational Safety and Health Act
Primary Goals of OSHA - Answer-1) To reduce injuries, illness and death
2) To provide leadership and encouragement to employees and workers to help
recognize and realize the value of safety and health on the job
CSHO - Answer-Compliance Safety and Health Officers
Compliance Safety and Health Offices - Answer-the designated individuals from OSHA
who could inspect your facility for at least one of 5 reasons
Five Reasons for OSHA inspection - Answer-1)Employe complaints
2)Fatalities
3)Routine inspections for High Hazard
4)Catastrophes (3 or more hospitalized)
5)General inspections
Risk Analysis - Required Administrative SafeGuard - Answer-Conduct an accurate and
thorough assessment of the potential risks and vulnerabilities to the confidentiality,
integrity, and availability of electronic PHI held by a covered entity.
Risk Management - Required Administrative Safeguard - Answer-Implement security
measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate
level to comply with the standard.
Sanction Policy -Required Administrative Safeguard - Answer-Apply appropriate
sanctions against workforce members who fail to comply with the security policies and
procedures of a covered entity.
Information system activity review -Required Administrative Safeguard - Answer-
implement procedures to regularly review records of information system activity, such
as audit logs, access reports, and security incident tracking reports.
Assigned security responsibility -Required Administrative Safeguard - Answer-Identify
the security official who is responsible for the development and implementation of the
policies and procedures required by this subpart for the entity.
Workforce Security -Required Administrative Safeguard - Answer-Implement policies
and procedures to ensure that all members of the workforce have the appropriate
