CPMA STUDY QUESTIONS & ANSWERS(RATED A+)

WHAT IS THE IMPORTANCE OF AUDIT IN A PRACTICE? - ANSWER 1. Reviewing quality of care provided to patients. 2. Educating providers on documentation. 3. Ensuring all services are supported and all appropriate revenue is captured. 4. Defending against external audit malpractice litigation and health plan request and denial. They can't bill federal or state for any services provided .3 length: host less than five years .4 When exclusionary period has ended dr must apply for reinstatement and receive authorize notice from OIG that reinstate has been granted Abuse - ANSWER In action resulting in unnecessary cost to a federal healthcare program either directly or indirectly What is the civil penalty - ANSWER Not less than 5000 and not more than 10,000 per claim x3 times the amount of government damages Federal False Claims Act - ANSWER Having knowledge that claims is fake. .1 knowing and knowingly that a person must act in deliberate ignorance of the truth or falsely of the relevant information or act in a reckless manner of the truth or falsity of the Information Qui Tam - ANSWER whistleblower what percentage is offered for a whistleblower/qui tam as an award from what is recovered by the government? - ANSWER between 15% and 25% fraud - ANSWER Knowingly making false statements or misrepresenting facts to obtain an undeserved benefit or payment from federal healthcare program Discovery sample - ANSWER CIA - 50 samples units randomly selected *determines the net financial error rate .2 if error rate exceeds 5% a full sample must be reviewed HHS OIG 3 core publications - ANSWER plan nnual report to congress 3. compendium unimplemented recommendation non-compliant conduct must be documented in compliance files & should include - ANSWER 1. date of incident of the reporting party