Aaham - Cct Exam With Complete Solutions Latest Update, Exams of Nursing

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Aaham - Cct Exam With Complete

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AABB - correct answers American Association of Blood Banks; one of six CMS- approved accreditation organizations Abuse - correct answers Improperly, and often unknowingly, violating regulations ALJ hearing - correct answers The third level of Medicare appeal; the amount in controversy threshold for 2012 is $ American Association of Blood Banks - correct answers AABB; one of six CMS - approved accreditation organizations. American Osteopathic Association - correct answers AOA; one of six CMS - approved accreditation organizations American Society of Histocompatibility and Immunogenetics - correct answers ASHI; one of six CMS - approved accreditation organizations

Anti-Kickback Statute - correct answers The Act that makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration for referrals of items or services reimbursable by a federal healthcare program AOA - correct answers American Osteopathic Association; one of six CMS - approved accreditation organizations Appeals Council Review - correct answers The fourth level of appeal; which can be requested if the provider is not satisfied with the Administrative Law Judge's decision ASCA - correct answers Administrative Simplification Compliance Act ASHI - correct answers American Society of Histocompatibility and Immunogenetics; one of six CMS - approved accreditation organizations Automated review - correct answers A RAC review using various types of analytics to identify improper payments; usually done without a human review of the medical records CAP - correct answers College of American Pathologists; one of six CMS - approved accreditation organizations

CERT - correct answers Comprehensive Error Rate Testing program instituted by CMS to monitor and calculate the accuracy and error rates for all MAC's and to monitor the accuracy of Medicare payments to FIs, carriers, and DMERCs Certificate of Provider Performed Microscopy - correct answers The CLIA certificate issued to a laboratory in which a physician, mid-level practitioner, or dentist performs specific microscopy procedures during the course of a patient's visit Certificate of Accreditation - correct answers COA; the CLIA certificate issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS Certificate of Compliance - correct answers COC; the CLIA certificate issued to a laboratory once the State Department of Health conducts an on-site survey/ inspection and determines that the laboratory is compliant with all applicable CLIA requirements Certificate of Registration - correct answers The CLIA certificate issued to allow a laboratory to conduct nonwaived testing until the laboratory is surveyed to determine its compliance with the CLIA regulations

Certificate of Waiver - correct answers COW; the CLIA certificate issued to a laboratory that performs only waived tests -"simple laboratory examinations and procedures that have an insignificant risk of an erroneous result" CIA - correct answers Corporate Integrity Agreement -the agreement that spells out the integrity measure required of a provider that has engaged in serious misconduct but is being allowed to continue participating in the healthcare programs, or Central Intelligence Agency CLIA - correct answers Clinical Laboratory Improvement Amendment; the amendments that established quality standards for all laboratory testing CMP - correct answers Civil Monetary Penalties CMS - correct answers Centers for Medicare and Medicaid Services CMS Central Office Alert - correct answers one of the five types of Fraud Alerts; prepared by ZPIC if a scheme is about to be publicized on a national level, the case involves patient abuse or a large dollar amount , or the issue involves politically sensitive testimony

COA - correct answers Certificate of Accreditation; the CLIA certificate issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS COC - correct answers Certificate of Compliance; the CLIA certificate issued to a laboratory once the State Department of Health conducts an on-site survey /inspection and determines that the laboratory is compliant with all applicable CLIA requirements COLA - correct answers Commission on Office Laboratory Accreditation; one of six CMS-approved accreditation organizations College of American Pathologists - correct answers CAP; one of six CMS- approved accreditation organizations Commission on Office Laboratory Accreditation - correct answers COLA; one of six CMS-approved accreditation organizations complex review - correct answers a RAC review involving review of the medical record documentation; used where there is a high probability that the service is not covered

or where no Medicare policy, Medicare article, or Medicare-sanctioned coding guideline exists Comprehensive Error Rate Testing - correct answers CERT; a program instituted by CMS to monitor and calculate the accuracy and error rates for all MACs and to monitor the accuracy of Medicare payments to FIs, carriers and DMERCs COP - correct answers Medicare Conditions of Participation Corporate Integrity Agreement - correct answers the agreement that spells out integrity measures required of a provider that has engaged in serious misconduct but is being allowed to continue participating in the healthcare programs COW - correct answers Certificate of Waiver; the CLIA certificate issued to a laboratory that performs only waived tests -"simple laboratory examinations and procedures that have an insignificant risk of an erroneous result" CPG - correct answers Compliance Program Guidance

demand letter - correct answers document describing the rationale for a RAC determination and providing information in case an appeal is warranted DOJ - correct answers Department of Justice EHR - correct answers electronic health record EMC - correct answers emergency medical condition Emergency Medical Treatment and Active Labor Act - correct answers EMTALA; the Act that requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition; also known as the Federal Anit- Dumping Statute EMR - correct answers electronic medical record EMTALA - correct answers Emergency Medical Treatment and Active Labor Act

EPHI - correct answers electronic protected health information Fair Credit Billing Act - correct answers an amendment to the Truth in Lending Act that protects consumers from inaccurate or unfair practices by issuers of open-ended credit Fair Credit Reporting Act - correct answers Title VI of the Consumer Credit Protection Act that defines what information from consumer reports can be used, by whom, and when Fair Debt Collection Practices Act - correct answers Title VIII of the Consumer Credit Protection Act that protects consumers from abusive, deceptive, and unfair collection practices False Claims Act - correct answers the Act that helps recover billions of dollars stolen through fraud while also protecting whistleblowers from retaliation FDA - correct answers Food and Drug Administration Federal Anti-Dumping Statute - correct answers another name for EMTALA

Fraud - correct answers willingly and knowingly violating regulations full denial - correct answers a RAC denial that occurs when the RAC determines that the service was not reasonable or necessary or that the service billed to CMS was not rendered GAO - correct answers General Accounting Office; one of two government entities that produces reports every year that review and analyze aspects of Medicare payments GME - correct answers Graduate Medical Education HCFAC - correct answers Health Care Fraud and Abuse Control program established by HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs HCQIP - correct answers Health Care Quality Improvement Program; a program that supports the mission of CMS to assure healthcare security for beneficiaries Health Care Fraud and Abuse Control - correct answers HCFAC; a program established by HIPAA to combat waste, fraud, and abuse in the Medicare and Medicaid programs

Health Care Quality Improvement Program - correct answers HCQIP; a program that supports the mission of CMS to assure healthcare security for beneficiaries Health Information Technology for Economic and Clinical Health - correct answers HITECH; an Act intended to accelerate the adoption of EHRs/EMRs among providers Health Insurance Portability and Accountability Act - correct answers HIPAA; an Act passed in 1996 to improve portability and continuity of health insurance coverage; to combat waste, fraud and abuse in health insurance and healthcare delivery; to promote the use of medical savings accounts; to improve access to long-term care services and coverage; to simplify the administration of health insurance, etc. HHS - correct answers Department of Health and Human Services HIPAA - correct answers Health Insurance Portability and Accountability Act HITECH - correct answers Health Information Technology for Economic and Clinical Health Act; an Act intended to accelerate the adoption of EHRs/EMRs among providers

hospital - correct answers an institution primarily engaged in providing inpatient diagnostic and therapeutic services, outpatient, or rehabilitation services Hospital Payment Monitoring Program - correct answers HPMP; a program responsible for monitoring payments to inpatient acute care hospitals ICD - correct answers International Classification of Diseases IME - correct answers Indirect Medical Education IOM - correct answers Institute of Medicine JCAHO - correct answers Joint Commission on Accreditation of Healthcare Organizations; former name for the Joint Commission- TJC Joint Commission on Accreditation of Healthcare Organizations - correct answers JCAHO; former name for the Joint Commission -TJC Judicial Review - correct answers the fifth level of appeal, which can be done if the denial issue is still in controversy following the Appeals Council's decision

MAC - correct answers Medicare Administrative Contractor Medicaid Fraud Control Unit - correct answers federal-and state- funded law enforcement entities that investigate and prosecute provider fraud and violations of state law pertaining to fraud in the Medicaid program; they also review complaints of resident abuse or neglect in nursing homes and other health care facilities Medicaid Integrity Contractor - correct answers private company that conducts audit-related activities under a contract with CMS Medicare Secondary Payer - correct answers MSP; provisions to protect the Medicare Trust Fund by ensuring that Medicare does not pay for services and items that certain other health insurance or coverage is primarily responsible for paying MedWatch - correct answers an FDA reporting system that encourages physicians and facilities to report voluntarily serious adverse events that occur as a result of drug reactions MIC - correct answers Medicaid Integrity Contractor

National Medicare Fraud Alert - correct answers one of the five types of Fraud Alerts; the most commonly issued type that focuses on a particular scheme or scam and serves as a fraud detection lead NPI - correct answers National Provider Identifier OAS - correct answers Office of Audit Services; the OIG component that conducts financial and performance audits of departmental programs, operations, grantees, and contractors OCIG - correct answers Office of Counsel to the Inspector General; the OIG component that provides legal advice and representation to the OIG on matters relating to Medicare, Medicaid, and other HHS programs and operations OCR - correct answers Office for Civil Rights; the entity that is responsible for enforcing the HIPAA Privacy Rule OEI - correct answers Office of Evaluation and Inspections; the OIG component that conducts national evaluations to provide Congress, HHS, and the public with timely, useful, and reliable information on significant issues

Office for Civil Rights - correct answers OCR; the entity that is responsible for enforcing the HIPAA Privacy Rule Office of Audit Services - correct answers OAS; the OIG component that conducts financial and performance audits of departmental programs, operations, grantees, and contractors Office of Counsel to the Inspector General - correct answers OCIG; the OIG component that provides legal advice and representation to the OIG on the matters relating to Medicare, Medicaid, and other HHS programs and operations Office of Evaluation and Inspections - correct answers OEI; the OIG component that conducts national evaluations to provide Congress, HHS, and the public with timely, useful, and reliable information on significant issues Office of Inspector General - correct answers OIG; part of the HHS and the principal driver in the implementation of compliance Office of Investigations - correct answers OI; the OIG component that conducts and coordinates investigations

of fraud and misconduct related to the Department's programs, operations, and beneficiaries OI - correct answers Office of Investigations; the OIG component that conducts and coordinates investigations of fraud and misconduct related to the Department's programs, operations, and beneficiaries OIG - correct answers Office of Inspector General; part of the HHS and the principal driver in the implementation of compliance Operation Restore Trust - correct answers ORT; a pilot, voluntary disclosure program of potential violations as a way to fight fraud and abuse in the Medicare and Medicaid programs partial denial - correct answers a RAC denial that occurs when the RAC determines that the service was not reasonable or necessary but that a lower level service would be, or when the service was upcoded or an incorrect code was submitted which yielded a higher reimbursement of the service Patient Protection and Affordable Care Act - correct answers PPACA; a law that established an obligation under the False Claims Act to report and return identified

Medicare or Medicaid payments within 60 days after the date on which the overpayment was identified PCCM - correct answers Primary Care Case Management PHI - correct answers protected health information PHSA - correct answers Public Health Service Act; the Act that provides for exemption of CLIA requirements in states with requirements that are equal to or more stringent than CLIA's PPM - correct answers Provider Performed Microscopy Program Safeguard Contractor and Zone Program Integrity Contractor BI Unit Alert - correct answers one of the five types of Fraud Alerts Provider- Self Discloser Protocol - correct answers a publication by the OIG to promote voluntary disclosure of potential violations providers - correct answers Medicare-participating entities

Public Health Service Act - correct answers PHSA; the Act that provides for exemption if CLIA requirements in states with requirements that are equal to or more stringent that CLIA's QIOSC - correct answers Quality Improvement Organizations Support Centers qui tam - correct answers provisions in the False Claims Act that protect whistleblowers from retaliation and allow them to sue, on behalf of the government, in order to recover the stolen funds RAC - correct answers Recovery Audit Contractor RAC Date Warehouse - correct answers an important tool for measuring the performance of the Recovery Auditors; source of data so providers can gain knowledge about the recovery program and so that compliance officers will know what healthcare areas the facilities should review; allows CMS to generate reports to show the types of claims that the RACs are reviewing, as well as which healthcare issue is increasing in the number of corrected claims reconsideration - correct answers the second level of appeal, which is requested if the provider is dissatisfied with the redetermination results

Recovery Audit Contractor - correct answers recipient of a contract to help guard the operations of the Medicare Trust Fund Recovery Audit Programs - correct answers a program created by Congress to identify improper Medicare payments and to help fight fraud, waste, and abuse in the government program redetermination - correct answers the first level of appeal, in which a claim is reviewed by Medicare Area Contractor personnel different from the personnel who made the initial denial determination remuneration - correct answers anything of value Restricted Medicare Fraud Alert - correct answers one of the five types of Fraud Alerts Safe Harbor - correct answers regulations developed to identify specific payment and business practices, that while potentially prohibited by the Anit-Kickback Statute, would not be prosecuted semi-automated review - correct answers one of the three processes followed by Recovery Auditors to identify

improper payments; the review is determined by data mining but records may be sent to justify the charges State Survey Agency - correct answers the entity that evaluates and certifies hospitals for compliance with Medicare requirements Telephone Consumer Protection Act of 1991 - correct answers TCPA; a law that amended the Communications Act of 1934 and restricts telephone solicitations (in other words, telemarketing) and the use of automated telephone equipment The Joint Commission - correct answers TJC; one of six CMS-approved accreditation organizations TJC - correct answers The Joint Commission; one of six CMS-approved accreditation organizations Truth in Lending Act - correct answers Title I of the Consumer Credit Protection Act also known as Regulation Z; deals with the discloser of information before credit is extended Waiver Alerts - correct answers one of the five types of Fraud Alerts

Zone Program Integrity Contractors -ZPIC - correct answers contractors used by CMS to identify problem areas, investigate potential fraud, and develop fraud cases for referrals to law enforcement Incorrect reporting of diagnosis and procedures to maximize payments - an example of abuse or fraud? - correct answers An example of fraud Altering claim forms to obtain a higher payment- an example of abuse or fraud? - correct answers An example of fraud Submitting a claim at a higher level of service than was actually rendered- frequently referred to as "up-coding"- an example of abuse or fraud? - correct answers An example of fraud Using another individual's Medicare Insurance card to obtain medical care- an example of abuse or fraud? - correct answers An example of fraud Unbundling or "exploding" charges- an example of abuse or fraud? - correct answers An example of fraud

Billing non-covered or non-chargeable services as covered items- an example of abuse or fraud? - correct answers An example of fraud Charging in excess for services or supplies- an example of abuse or fraud? - correct answers An example of abuse Providing medically unnecessary services- an example of abuse or fraud? - correct answers An example of abuse Providing services that do not meet professional recognized standards- an example of abuse or fraud? - correct answers An example of abuse Submitting bills to Medicare that are the responsibility of other insurers- an example of abuse or fraud? - correct answers An example of abuse Breaches in the assignment of benefit agreement- an example of abuse or fraud? - correct answers An example of abuse Violators of fraud - correct answers Physicians or other practioner; hospital or other institutional provider; billing service; beneficiary; Medicare Contractor employee; Employee of any provider

Elements of an effective compliance plan - correct answers Implementing written policies; Designating a compliance officer or contact; Conducting comprehensive training and education; Developing accessible lines of communication; Conducting internal monitoring and auditing; Enforcing standards through well-publicized disciplinary guidelines; and Responding promptly to detected offenses and undertaking corrective action Benefits of an Effective Compliance Plan - correct answers Improves the quality of patient care; initiates immediate and appropriate corrective action; Identifies and prevents criminal and unethical conduct; Demonstrates the hospital's commitment to be an honest and responsible provider; Encourages employees to report potential problems; With early detection and reporting, can reduce a hospital's exposure to civil damages and penalties Not considered parts of the hospital (not to be included in the evaluation of hospital's compliance) - correct answers Components appropriately certified as other kinds of providers or suppliers( for example, Home Health Agency, Hospice, and Rural Health Clinics); and Excluded residential, custodial, and non-service units not meeting certain definitions in the Social Security Act If the hospital is accredited by these it is deemed to meet all Medicare requirements for hospitals - correct answers

The Joint Commission(TJC) and the American Osteopathic Association (AOA) Financial Audits - correct answers Principally provide reasonable assurance about whether financial statements are presented fairly Performance Audits - correct answers Assess the achievement of objectives and identify the presence of systematic weaknesses giving rise to waste, fraud, or abuse The Social Security Act - correct answers Mandates the establishment of health, safety, and CLIA standard that must be met by suppliers and providers who participate in the Medicare and Medicaid Programs The OEI Evaluations - correct answers Focus on preventing fraud, waste, or abuse; Promoting economy, efficiency, and effectiveness of departmental programs Represents the OIG in all civil and administrative fraud and abuse cases involving the HHS programs, including the False Claims Act, program exclusions, and civil monetary pent cases - correct answers The Office of Counsel to the Inspector General (OCIG)

Negotiates and monitors corporate Integrity agreements - correct answers The Office of Counsel to the Inspector General (OCIG) Renders advisory opinions, issues fraud alerts, and provides other guidance to the healthcare industry concerning the federal Anti-Kickback Statute and OIG sanctions - correct answers The Office of Counsel to the Inspector General (OCIG) Non compliant activities can bring - correct answers civil monetary penalties, assessments , fines, sanctions, imprisonment, exclusion from the program, loss of Medicare certification, and facility closure The evaluation and certification/ accreditation process - correct answers It is not permissible to certify only part of a general hospital; A hospital accredited by TJC (formerly JCAHO) and the AOA is deemed to meet all Medicare requirements for hospitals; An individual or entity should allow immediate access, upon reasonable request, to a surveyor Violating the Anti-Kickback Statute - correct answers can result in nonpayment of claims, civil monetary penalties, exclusion from the Medicare program, liability for submitting false claims to the government, imprisonment, and criminal fines

MFCU Performance Standards - correct answers Compliance with Requirements; Staffing; Policies and Procedures; Maintaining Adequate Referrals; Maintaining a Continuous Case Flow; Case Mix; Maintaining Case Information; Cooperation with Federal Authorities on Fraud Cases; Program Recommendations; Agreement with Medicaid Agency; Fiscal Control; and Training Seven Core elements of a CIA - correct answers Hire a compliance officer and appoint a compliance committee; Develop written standards and policies ; Implement a comprehensive employee training program; Review claims submitted to federal healthcare programs; Establish a confidential disclosure program; Restrict employment if ineligible persons; Submit a variety of reports to the OIG Fraud Alerts - correct answers are issued when there is a need to advise governmental agencies about activities that have resulted in the filing of inappropriate and potentially false Medicare claims The five types of Fraud Alerts - correct answers National Medicare Fraud Alerts; Restricted Medicare Fraud Alert; CMS Central Office Alert; Program Safeguard Contractor and Zone Program Integrity Contractor BI Unit Alert; Waiver Alert