Medicare fraud Study guides, Class notes & Summaries
Looking for the best study guides, study notes and summaries about Medicare fraud? On this page you'll find 3475 study documents about Medicare fraud.
All 3.475 results
Sort by
-
CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023
- Exam (elaborations) • 18 pages • 2023
- Available in package deal
-
- $32.49
- 4x sold
- + learn more
CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 
Steps used to control costs of managed care include: 
Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
 
 
DRG is used to classify 
Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
 
 
Identify the various types of private health plan coverage 
HMO 
Conventional 
PPO and POS 
H...
-
UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE
- Exam (elaborations) • 14 pages • 2023 Popular
- Available in package deal
-
- $10.99
- 3x sold
- + learn more
UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE 
 
Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? 
 
 
Answer: 
Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...
-
AHIP TRAINING Medicare Fraud, Waste, and Abuse Training EXAM 50+ QUESTIONS AND VERIFIED CORRECT ANSWERS 2023.
- Exam (elaborations) • 11 pages • 2023
- Available in package deal
-
- $11.49
- 1x sold
- + learn more
AHIP TRAINING Medicare 
Fraud, Waste, and Abuse 
Training EXAM 50+ 
QUESTIONS 
AND VERIFIED CORRECT 
ANSWERS 2023. 
AHIP TRAINING Medicare Fraud, Waste, and Abuse Training 
1. Medicare plan means: A MA plan, MA-PD plan or PDP 
2. Subcontractor means: **An individual or entity that provides services on behalf 
of a Medicare plan sponsor. This includes individuals and organizations with 
DIRECT relationship with the plan sponsor or individuals or organizations with 
INDIRECT relationship, such as ...
-
Medicare Fraud, Waste, & Abuse (2022/2023) (Certified Answers)
- Exam (elaborations) • 6 pages • 2023
- Available in package deal
-
- $9.99
- 1x sold
- + learn more
Medicare Fraud, Waste, & Abuse (2022/2023) (Certified Answers) 
Your 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? 
a.Do what your immediate supervisor asked you to do and adjust or add risk diagnosis co...
-
CPCO Test Prep Questions Bank | 455 Questions with 100% Correct Answers | Verified | Latest Update | 68 Pages
- Exam (elaborations) • 68 pages • 2023
-
- $20.49
- 2x sold
- + learn more
Does Medicare pay for all tests ordered by Providers? - No, they need to determine if it's 
covered and medically necessary. 
For larger physician practices, how often does the OIG suggest reporting compliance activities to 
the board of directors? - Regularly 
According to the OIG, medically unnecessary services can be billed to Medicare for what 
purpose? - To receive a denial so a claim can be submitted to a secondary payer. 
Which component of the OIG has a duty of operating the OIG hotline...
Too much month left at the end of the money?
-
Medical Billing and Coding Practice Test Exam Verified Answers 2023
- Exam (elaborations) • 21 pages • 2023
- Available in package deal
-
- $11.00
- 2x sold
- + learn more
National Coverage Determination (NCD) - Which of the following Medicare 
policies determines if a particular item or service is covered by Medicare? 
Adjudication - Which of the following is considered the final determination of the 
issues involving settlement of an insurance claim? 
Encounter Form - A form that contains charges, DOS, CPT codes, ICD codes, fees 
and copayment information 
Admitting clerk - A patient comes to the hospital for an inpatient procedure. Which 
of the following hospi...
-
CSPR - Certified Specialist Payment Rep (HFMA) Exam 2023 with Complete Solutions
- Exam (elaborations) • 18 pages • 2023
-
- $13.49
- 9x sold
- + learn more
Steps used to control costs of managed care include: - ANSWER-Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
Identify the various types of private health plan coverage - ANSWER-HMO 
Conventional 
PPO and POS 
HDHP/SO plans - high-deductible health plans with a savings...
-
UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE
- Exam (elaborations) • 17 pages • 2023
- Available in package deal
-
- $10.99
- 1x sold
- + learn more
UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE 
 
 
Q: John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? 
 
 
Answer: 
John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. 
 
 
 
Q: In which of the...
-
AHIP TRAINING Medicare Fraud, Waste, and Abuse Training | Latest Version 2024/2025 | Expert Verified | Ace the Test
- Exam (elaborations) • 20 pages • 2024
-
- $12.49
- + learn more
AHIP TRAINING Medicare Fraud, Waste, and Abuse Training | 
Latest Version 2024/2025 | Expert Verified | Ace the Test
-
HCCA - CHC Study Questions and Answers (Graded A)
- Exam (elaborations) • 128 pages • 2023
-
- $20.49
- 1x sold
- + learn more
True or False: 
The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True 
 
ref. ACA section 6102 
 
According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 
2.Protect your patients 
3.Protect the Provider 
 

 
At which level of the Medicare Part A or Part B appeals process is the app...
$6.50 for your textbook summary multiplied by 100 fellow students... Do the math: that's a lot of money! Don't be a thief of your own wallet and start uploading yours now. Discover all about earning on Stuvia