Specific risk areas identified by OIG include:
Answer:
1. Billing for items or services not rendered or not provided as claimed.
2. Submitting claims for equipment, medical supplies, and services that are not reasonable and necessary.
3. Double billing, resulting in duplicate payment.
4. Billing for non-covered services as if covered.
5. Knowing misuse of provider identification numbers, which results in improper billing.
6. Unbundling, or billing for each component of the service instead of billing or using an all-inclusive code.
7. Failure to use coding modifiers properly.
8. Up-coding the level of service provided.
HIS 124
- Components of record retention are: _________
- ______ is what happens to the patient data after the patient is discharged.
- An ________ contains: data and time, list of the activities, the computer in which the activity took place, the user who performed the activity, and a description of the activity itself.
- The correction of errors is an important consideration in patient record keeping because nothing that is recorded should be ________
- The process of determining the cause of an error is often referred to as a ________.
- A ______ might be programmed to print out a list of entries that the compute recognizes as problematic.
- _____ are developed and implemented to ensure that errors in data are discovered.
- One way to prevent invalid data entries is with the use of _____ on a printed form of computer screen.
- ____ are designed to ensure that data errors do not occur in the first place. the best example of a preventive control is a compute validity check.
- One way that data can be protected so that they are accurate, valid, timely, and complete is through the development and implementation of _______
- ___ refers to the collection or recording of data in their entirety.
- A history and physical (H&P) must be completed within ______ of admission or before a surgical procedure.
- The process of recording data into an information system is called ______
- _____ ensures its usefulness. the term validity pertains to the data's conformity with an expected range of values. a computer can be instructed to check specific fields for validity and alert the user to a potential data collection error.
- One consideration that is more important in computer data entry than in paper-record data collection is the _____
- Computerized data capture facilitates the improvement of ________
- Effective training can reduce potential _____ .
- The _____ acts as a review board regarding HIPAA.
- In addition, policies should be developed in compliance with HIPAA that address the following:
- Seven Basic Components of a Compliance Plan is
- The _____ prohibit the submission of claims for designated services or referral of patients if the referring physician has a "financial relationship" with the entity that provides the services.
- Federal False Claims Act addresses presenting a claim for an item or service based on a code known to result in greater payment or submitting a claim for services _____.
- ___ occurs when a health care organization practices behavior that is not indicative of sound medical or fiscal activity.
- ___ can occur when deception is used. Individuals who knowingly, willfully and intentionally submit false information to benefit themselves of others commit fraud.