CDEO EXAM LATEST
HHS - ANSWERS-Health and Human Services
exclusionary period has ended - ANSWERS-the individual or entity
must apply for reinstatement and receive authorized notice from OIG
that reinstatement has been granted.
The OIG has identified seven elements - ANSWERS-Seven elements
that should be present in every compliance plan based on criteria
adopted by the federal government in the federal sentencing guidelines.
The OIG lists seven fundamental elements for an effective compliance
program, which are:1-Implementing written policies, procedures and
standards of conduct;2-Designating a compliance officer and/or
compliance committee;3-Conducting effective training and education;4-
Developing effective lines of communication;5-Enforcing standards
through well-publicized disciplinary guidelines;6-Conducting internal
monitoring and auditing; and7-Responding promptly to detected
offenses and developing corrective action
the OIG Compliance Guidance for Individual and Small Group
Physician Practices - ANSWERS-lists unbundling as a potential risk
area among others.
five years -OIG - ANSWERS-When a physician is banned from
participating in any Federal or State health care program by the OIG
END OF
PAGE
1
, CDEO EXAM LATEST
under the Exclusion Statute (42 U.S.C. § 1320a-7), what is the minimum
term of exclusion that can be applied?
OIG noncompliance - ANSWERS-disciplinary action should be taken
based on the severity of the offense. Disciplinary actions could include
oral warnings, written reprimands, probation, demotions, termination,
etc. The incident should be documented with the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
Qui Tam Relator - ANSWERS-A person who brings a civil action for a
violation for him-/herself and for the U.S. Government.
compliance program guidance documents by the OIG - ANSWERS-Any
finding of non-compliant conduct must be documented in the
compliance files and should include:· date of incident· name of the
reporting party· name of the person responsible for taking action· the
follow-up action taken
CMS defines fraud - ANSWERS-making false statements or
misrepresenting facts to obtain an undeserved benefit or payment from a
federal health care program. CMS defines abuse as an action that results
in unnecessary costs to a Federal health care program, either directly or
indirectly.
END OF
PAGE
2
, CDEO EXAM LATEST
Compliant query questions - ANSWERS-ask the question in a way that
will generate an original response. By asking if the provider knows the
cause of the fever, you will know whether this is a surgical
complication.
Provider Query Rational - ANSWERS-It is inappropriate to query a
provider to improve reimbursement. This may be the result of the query,
but the goal of a query should always be to sharpen the clinical
documentation to improve clinical outcomes. Therefore, I. would be
incorrect. Queries are written to improve documentation, and may be
used as an educational tool to improve physician documentation. A
query is meant to clarify the record so that the correct codes can be
abstracted. Clarifying the record may include determining if a causal
relationship exists between two conditions, so that the causal
relationship can be reported. Queries are also used to resolve conflicting
or obscure documentation.
As a CDI professional, how can you utilize information provided in the
OIG Work Plan to improve documentation? - ANSWERS-Review of the
OIG Workplan provides information on services that will be audited by
the OIG. It is a best practice to review the services that appear on the
OIG workplan that you are performing in your office.
END OF
PAGE
3
, CDEO EXAM LATEST
The Medicare home health benefit - ANSWERS-covers intermittent
skilled nursing care, physical therapy, speech-language pathology
services, continued occupational services, medical social worker
services, and home health aide services. For CY 2014, Medicare paid
home health agencies (HHAs) about $18 billion for home health
services. Centers for Medicare & Medicaid Services' Comprehensive
Error Rate Testing (CERT) program determined that the 2014 improper
payment error rate for home health claims was 51.4 percent, or about
$9.4 billion. Recent OIG reports have similarly disclosed high error rates
at individual HHAs. Improper payments identified in these OIG reports
consisted primarily of beneficiaries who were not homebound or who
did not require skilled services. We will review compliance with various
aspects of the home health prospective payment system and include
medical review of the documentation required in support of the claims
paid by Medicare. We will determine whether home health claims were
paid in accordance with Federal requirements.
To be eligible for Medicare home health services a patient must have
Medicare Part A and/or Part B per Section1814(a)(2)(C) and Section
1835(a)(2)(A) of the Social Security Act (the Act):
• Be confined to the home;
• Need skilled services;
• Be under the care of a physician;
• Receive services under a plan of care established and reviewed by a
physician; and
END OF
PAGE
4
HHS - ANSWERS-Health and Human Services
exclusionary period has ended - ANSWERS-the individual or entity
must apply for reinstatement and receive authorized notice from OIG
that reinstatement has been granted.
The OIG has identified seven elements - ANSWERS-Seven elements
that should be present in every compliance plan based on criteria
adopted by the federal government in the federal sentencing guidelines.
The OIG lists seven fundamental elements for an effective compliance
program, which are:1-Implementing written policies, procedures and
standards of conduct;2-Designating a compliance officer and/or
compliance committee;3-Conducting effective training and education;4-
Developing effective lines of communication;5-Enforcing standards
through well-publicized disciplinary guidelines;6-Conducting internal
monitoring and auditing; and7-Responding promptly to detected
offenses and developing corrective action
the OIG Compliance Guidance for Individual and Small Group
Physician Practices - ANSWERS-lists unbundling as a potential risk
area among others.
five years -OIG - ANSWERS-When a physician is banned from
participating in any Federal or State health care program by the OIG
END OF
PAGE
1
, CDEO EXAM LATEST
under the Exclusion Statute (42 U.S.C. § 1320a-7), what is the minimum
term of exclusion that can be applied?
OIG noncompliance - ANSWERS-disciplinary action should be taken
based on the severity of the offense. Disciplinary actions could include
oral warnings, written reprimands, probation, demotions, termination,
etc. The incident should be documented with the date of the incident,
name of the reporting party, name of the person responsible for taking
action, and the follow-up action taken.
Qui Tam Relator - ANSWERS-A person who brings a civil action for a
violation for him-/herself and for the U.S. Government.
compliance program guidance documents by the OIG - ANSWERS-Any
finding of non-compliant conduct must be documented in the
compliance files and should include:· date of incident· name of the
reporting party· name of the person responsible for taking action· the
follow-up action taken
CMS defines fraud - ANSWERS-making false statements or
misrepresenting facts to obtain an undeserved benefit or payment from a
federal health care program. CMS defines abuse as an action that results
in unnecessary costs to a Federal health care program, either directly or
indirectly.
END OF
PAGE
2
, CDEO EXAM LATEST
Compliant query questions - ANSWERS-ask the question in a way that
will generate an original response. By asking if the provider knows the
cause of the fever, you will know whether this is a surgical
complication.
Provider Query Rational - ANSWERS-It is inappropriate to query a
provider to improve reimbursement. This may be the result of the query,
but the goal of a query should always be to sharpen the clinical
documentation to improve clinical outcomes. Therefore, I. would be
incorrect. Queries are written to improve documentation, and may be
used as an educational tool to improve physician documentation. A
query is meant to clarify the record so that the correct codes can be
abstracted. Clarifying the record may include determining if a causal
relationship exists between two conditions, so that the causal
relationship can be reported. Queries are also used to resolve conflicting
or obscure documentation.
As a CDI professional, how can you utilize information provided in the
OIG Work Plan to improve documentation? - ANSWERS-Review of the
OIG Workplan provides information on services that will be audited by
the OIG. It is a best practice to review the services that appear on the
OIG workplan that you are performing in your office.
END OF
PAGE
3
, CDEO EXAM LATEST
The Medicare home health benefit - ANSWERS-covers intermittent
skilled nursing care, physical therapy, speech-language pathology
services, continued occupational services, medical social worker
services, and home health aide services. For CY 2014, Medicare paid
home health agencies (HHAs) about $18 billion for home health
services. Centers for Medicare & Medicaid Services' Comprehensive
Error Rate Testing (CERT) program determined that the 2014 improper
payment error rate for home health claims was 51.4 percent, or about
$9.4 billion. Recent OIG reports have similarly disclosed high error rates
at individual HHAs. Improper payments identified in these OIG reports
consisted primarily of beneficiaries who were not homebound or who
did not require skilled services. We will review compliance with various
aspects of the home health prospective payment system and include
medical review of the documentation required in support of the claims
paid by Medicare. We will determine whether home health claims were
paid in accordance with Federal requirements.
To be eligible for Medicare home health services a patient must have
Medicare Part A and/or Part B per Section1814(a)(2)(C) and Section
1835(a)(2)(A) of the Social Security Act (the Act):
• Be confined to the home;
• Need skilled services;
• Be under the care of a physician;
• Receive services under a plan of care established and reviewed by a
physician; and
END OF
PAGE
4
