AHFI Exam Questions With Correct Answers

AHFI Exam Questions With Correct
Answers


Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - CORRECT
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ANSWER✔✔-Prohibits offering, paying, soliciting or reviving anything of value to
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induce or reward referrals or generate Federal health care program business
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Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - CORRECT ANSWER✔✔-
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Referrals from anyone | |




Anti-Kickback Statute (42 US SS 1320a-7b (b) - CORRECT ANSWER✔✔-Any items
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or services
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Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - CORRECT ANSWER✔✔-
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Intent MUST be proven (knowing and willful)
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Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - CORRECT
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ANSWER✔✔-Fines up to $25,000/violation | | |




Up to a 5-yr prison term/violation
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Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - CORRECT
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ANSWER✔✔-False Claims act liability | | |

,Civil monetary penalties and program exclusions
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Potential $50,000 CMP/violation
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Civil assessment of up to 3x amount of kickback
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Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - CORRECT ANSWER✔✔-
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Voluntary safe harbors
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Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - CORRECT
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ANSWER✔✔-All Federal Health Care Programs | | | |




The Stark Law (42 US SS 139nn) Prohibition - CORRECT ANSWER✔✔-Prohibits a
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physician from referring Medicare patients for designated health services to an
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entity with which the physician (or immediate family member) has a financial
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relationship, unless an exception applies)
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Prohibits the designated health services entity from submitting claims to
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Medicare for those services resulting from a prohibited referral
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The Stark Law (42 US SS 139nn) Referrals - CORRECT ANSWER✔✔-Referrals from
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a physician
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The Stark Law (42 US SS 139nn) (Items/Services) - CORRECT ANSWER✔✔-
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Designated health services
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,The Stark Law (42 US SS 139nn) (Intent) - CORRECT ANSWER✔✔-No intent
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standard for overpayment (strict liability)
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Intent required for civil monetary penalties for knowing violations
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The Stark Law (42 US SS 139nn) (Civil Penalties) only - CORRECT ANSWER✔✔-
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Overpayment/refund obligation |




False Claims Act liability
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Civil monetary penalties and program exclusion for knowing violations
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Potential $15,000 CMP for each service
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Civil assessment of up to 3x the amount claimed.
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The Stark Law (42 US SS 139nn) (Exceptions) - CORRECT ANSWER✔✔-Mandatory
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exceptions


The Stark Law (42 US SS 139nn) applies to - CORRECT ANSWER✔✔-Medicare and
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Medicaid |




(No commercial or tricare)
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, MACs: - CORRECT ANSWER✔✔-Medicare Administrative Contractors
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They analyze claims to determine provider compliance with Medicare coverage,
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coding, and billing rules and take appropriate corrective action when providers
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are found to be non-compliant.
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The goal of Mac administrative actions - CORRECT ANSWER✔✔-To correct the
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behavior in need of change and prevent future inappropriate billing
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The priority of MACs - CORRECT ANSWER✔✔-To minimize potential future losses
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to the Medicare Trust Fund through targeted claims review while using resource
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efficiently and treating providers and beneficiaries fairly.
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For repeated infractions, MACs have - CORRECT ANSWER✔✔-The discretion to
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initiate progressively more severe administrative action, commensurate with the
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seriousness of the identified problem. (See Program Integrity Manual (PIM)
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chapter 3, SS3. 7.1) | | |




Medicare Fee For Service Recovery Audit Program - CORRECT ANSWER✔✔-
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Legislative mandated program (Tax Relief and Health Care act of 2006)
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Utilizes Recovery Auditors to identify improper payments paid by Medicare to
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fee-for-service providers. | |




Recovery Auditors identify improper payments
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