Examen
Certified Revenue Cycle Representative Section 1 Cont. 2024/2025 graded A+ by experts
- Grado
- Institución
Certified Revenue Cycle Representative Section 1 Cont. 2024/2025 graded A+ by experts
[Mostrar más]Vista previa 2 fuera de 12 páginas
Vista previa 2 fuera de 12 páginas
Añadir al carrito
Añadir al carrito
Vendedor
Seguir
Ascore
Comentarios recibidos
Vista previa del contenido
Certified Revenue Cycle RepresentativeSection 1 Cont.
What is HIPAA? - ANSThe Health Insurance Portability and Accountability Act
When was HIPAA passed? - ANS1996
What are some of the HIPAA requirements that specifically address compliance? -
ANSCoordinating a fraud and abuse control program.
Establishing a fraud and abuse control account.
Increasing the civil money penalties.
Permitting the exclusion of individuals with ownership or control interest in a sanctioned entity.
What is PHI? - ANSPatient Health Information
Why were NPI's created? - ANSto eliminate the myriad of provider identifiers previously used
within the healthcare industry.
What is the goal of HIPAA? - ANSExpand health coverage by improving the portability and
continuity of health insurance coverage in group and individual markets.
Give patients access to their health files and the right to request amendments or make
corrections.
Facilitate the electronic exchange of medical information with respect to financial and
administrative transactions carried out by health plans, healthcare clearinghouses, and
healthcare providers.
What is required in order to allow external entities access to patient specific records or PHI. -
ANSBusiness Associate Agreements (BAA)
What is an NPI? - ANSNational Provider Identifier
What is the OIG? - ANSOffice of Inspector General
Why was the OIG created? - ANSto protect the integrity of the Health and Human Services
(HHS) Department programs and operations and the well-being of beneficiaries by detecting
and preventing fraud, waste, and abuse.
What are the OIG Responsibilities? - ANSIdentifying opportunities to improve program
economy, efficiency, and effectiveness.
Holding accountable those who do not meet program requirements or who violate federal laws.
, Who is the "Self-Police"? - ANSOffice of Inspector General (OIG)
Who follows the OIG? - ANSHome health agencies
Third-party medical billing companies
Medicare Advantage organizations
Hospice
Durable medical equipment (DME)
Prosthetics
Orthotics
Individual physicians and small group practices
Supply industry
Nursing facilities
Pharmaceutical companies
Ambulance providers
What happens when a providers violate CMS regulations? - ANSProviders are subject to
Corporate Integrity Agreements.
What are some key risk area's that can lead to potential fraud and abuse? - ANS"Upcoding" of
MS-DRG assignments
Inaccurate or incorrect coding
Bundling/unbundling of services
Duplicate billing
Billing for medically unnecessary services
Waiving of deductibles to entice business
Insufficient documentation
When did corporate compliance programs in healthcare begin to rise? - ANS1980's
What is the FERA? - ANSFraud Enforcement and Recovery Act
What is the FCA? - ANSFalse Claims Act
What does the FCA do? - ANSThe closure of loopholes, and to enhance the ability of the
government, whistleblowers, and reporting individuals to identify and successfully pursue
entities and individuals who improperly receive government funds.
Before FERA, whistleblowers could assert a claim under the False Claims Act only if the
provider had wrongfully obtained government funds to which the provider was not entitled.
If the provider received excessive funds as a result of an error by the government or innocent
mistake by the provider, the harsh penalties under the FCA did not apply.
Pursuant to the new legislation, whistleblowers can now bring a FCA action against providers
who knowingly and improperly keep government funds that are paid to them in error.
Los beneficios de comprar resúmenes en Stuvia estan en línea:
Garantiza la calidad de los comentarios
Compradores de Stuvia evaluaron más de 700.000 resúmenes. Así estas seguro que compras los mejores documentos!
Compra fácil y rápido
Puedes pagar rápidamente y en una vez con iDeal, tarjeta de crédito o con tu crédito de Stuvia. Sin tener que hacerte miembro.
Enfócate en lo más importante
Tus compañeros escriben los resúmenes. Por eso tienes la seguridad que tienes un resumen actual y confiable. Así llegas a la conclusión rapidamente!
Preguntas frecuentes
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
100% de satisfacción garantizada: ¿Cómo funciona?
Nuestra garantía de satisfacción le asegura que siempre encontrará un documento de estudio a tu medida. Tu rellenas un formulario y nuestro equipo de atención al cliente se encarga del resto.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Ascore. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for $11.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
45,681 summaries were sold in the last 30 days
Founded in 2010, the go-to place to buy summaries for 14 years now