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CPMA Chapter 1, Questions and answers, 100% Accurate, rated A

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CPMA Chapter 1, Questions and answers, 100% Accurate, rated A Stark Law - ✔✔-Physician Self Referral Law Prohibits a physician from making a referral to an entity with which they or their imme ... diate family has a financial relationship if the referral is for the furnishing of designated health services RAT-STATS - ✔✔-A statistical software that is a valuable analytical tool used by auditors Components of RAT-STATS that should be used to perform CIA Claims Review - ✔✔-"Random Numbers" to draw random samples for both the Discovery Sample and the Full Sample "Variable Appraisaisals" to calculate the mean & standard deviation of the overpayment amount in the sample "Sample Size Estimator" to estimate the size of the full sample CIA Reportable Events - ✔✔-1. A substantial overpayment 2. A potential violation of criminal, civil, or admistrative laws 3. Filing of a bankruptcy petition OIG Work Plan - ✔✔-Released annually and identifies priority areas for OIG review/investigation which the agency believes are HHS' most vulnerable programs and activities. The goal is to improve HHS agency efficiency and effectiveness. CIA - ✔✔-Coporate Integrity Agreement - an agreement between the OIG and a health care provider or other entity when serious misconduct (fraudulent or abusive type action) is discovered through an audit of self-disclosure. It is detailed and restrictive. Government can do this instead of excluding Typical term is 5 years OIG - ✔✔-Office of Inspector General - Mission is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries of those programs. Regulates: Corporate Integrity Agreements, Compliance Guidelines, Safe Harbor Regulations, and False Claims Act OAS - ✔✔-Office of Audit Services - Performs audits for [Show More]

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