AHFI Exam
- ANS-
-algia - ANS-pain
-asthenia - ANS-weak spot
-centesis - ANS-surgical puncture to do away with fluid
-ectomy - ANS-surgical removal
-ectomy - ANS-surgical removal (excision)
-emia - ANS-blood
-iasis - ANS-situation of
-lysis - ANS-destruction, break down
-lytic - ANS-to smash, break down
-oid - ANS-like, akin to
-oma - ANS-tumor
-opathy - ANS-sickness of
-opexy - ANS-surgical fixation
-oplasty - ANS-surgical repair
-orrhaphy - ANS-surgical repair or suture
-orrhea - ANS-float, discharge
-osis - ANS-extraordinary condition of
-ostomy - ANS-surgically create a brand new permanent opening
-otomy - ANS-reducing into (incision)
,-otripsy - ANS-crushing or destroying
-paresis - ANS-weak point
-plasia - ANS-boom
-plegia - ANS-paralysis
-pnea - ANS-breathing
1) Detection - ANS-The method of uncovering potential fraud, waste and abuse utilizing human
and technical sources and strategies
2-Types of Cases - ANS-Products instances - DME and Part D Pharmacy
Services Cases - Home health, PT-OT, CORF (Comprehensive Outpatient Rehab Facility
-CORF care is generally called outpatient rehabilitation care.) an , CMHC (Community Mental
Health Center).
2) The primary objective of the assessment phase is to set up ________ - ANS-PREDICATION
for the continued research
3) Investigative method - ANS-Developing an Investigative plan to identify and gather evidence
to assist the statutory factors to prove the case
30-calendar day time frame - ANS-Does ot observe to prepayment opinions of Third Party
Liability claims
The MACs shall make and input a evaluate willpower for Third Party Liability claims inside
60-calendar days
four) Case Investigation - ANS-The process of using prison and suitable strategies to show or
disprove the allegations
5) Report Writing - ANS-The technique of documenting the Investigative obligations in a very
last complete Investigative report
6 Determination of Action - ANS-Evaluating the totality of the documented case statistics to
decide the best movement to solve the research.
6 tiers of an investigation - ANS-Detection
Assessment
Investigative approach
, Case investigation
Report writing
Determination of motion
Ab- - ANS-faraway from
Ad- - ANS-towards
Additional Documentation Requests - ANS-If statistics is requested from each the billing issuer
or dealer and a 3rd birthday party and no response is obtained from both within
forty five-calendar days for MACs and RACs
Or 30-days for ZPICs/UPICs
After the date of the request (or inside an inexpensive time following an extension), the MACs,
RACs and ZPICs/UPICs shall deny the claim in full or in part as not affordable and essential.
Ambi - ANS-both
Amendments, corrections and Delayed Entries in Medical Documentation - ANS-All offerings
furnished to beneficiaries are anticipated to be documented in the scientific file at the time
they're rendered
The MACs, Cert, Recovery Auditors, and ZPICs shall NOT take into account any entries that do
no observe the standards indexed in section B, even supposing such exclusion could result in a
claim denial. (Example: They shall not keep in mind undated or unsigned entries handwritten
inside the margin of a report. They shall exclude these entries from attention.)
aniso- - ANS-unequal
Anterior or ventral - ANS-At or close to the front floor of the body
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANS-Any gadgets or services
Anti-Kickback Statute (forty two US SS 1320a-7b (b) - what it applies to... - ANS-All Federal
Health Care Programs
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANS-False Claims act
liability
Civil monetary consequences and software exclusions
Potential $50,000 CMP/violation
- ANS-
-algia - ANS-pain
-asthenia - ANS-weak spot
-centesis - ANS-surgical puncture to do away with fluid
-ectomy - ANS-surgical removal
-ectomy - ANS-surgical removal (excision)
-emia - ANS-blood
-iasis - ANS-situation of
-lysis - ANS-destruction, break down
-lytic - ANS-to smash, break down
-oid - ANS-like, akin to
-oma - ANS-tumor
-opathy - ANS-sickness of
-opexy - ANS-surgical fixation
-oplasty - ANS-surgical repair
-orrhaphy - ANS-surgical repair or suture
-orrhea - ANS-float, discharge
-osis - ANS-extraordinary condition of
-ostomy - ANS-surgically create a brand new permanent opening
-otomy - ANS-reducing into (incision)
,-otripsy - ANS-crushing or destroying
-paresis - ANS-weak point
-plasia - ANS-boom
-plegia - ANS-paralysis
-pnea - ANS-breathing
1) Detection - ANS-The method of uncovering potential fraud, waste and abuse utilizing human
and technical sources and strategies
2-Types of Cases - ANS-Products instances - DME and Part D Pharmacy
Services Cases - Home health, PT-OT, CORF (Comprehensive Outpatient Rehab Facility
-CORF care is generally called outpatient rehabilitation care.) an , CMHC (Community Mental
Health Center).
2) The primary objective of the assessment phase is to set up ________ - ANS-PREDICATION
for the continued research
3) Investigative method - ANS-Developing an Investigative plan to identify and gather evidence
to assist the statutory factors to prove the case
30-calendar day time frame - ANS-Does ot observe to prepayment opinions of Third Party
Liability claims
The MACs shall make and input a evaluate willpower for Third Party Liability claims inside
60-calendar days
four) Case Investigation - ANS-The process of using prison and suitable strategies to show or
disprove the allegations
5) Report Writing - ANS-The technique of documenting the Investigative obligations in a very
last complete Investigative report
6 Determination of Action - ANS-Evaluating the totality of the documented case statistics to
decide the best movement to solve the research.
6 tiers of an investigation - ANS-Detection
Assessment
Investigative approach
, Case investigation
Report writing
Determination of motion
Ab- - ANS-faraway from
Ad- - ANS-towards
Additional Documentation Requests - ANS-If statistics is requested from each the billing issuer
or dealer and a 3rd birthday party and no response is obtained from both within
forty five-calendar days for MACs and RACs
Or 30-days for ZPICs/UPICs
After the date of the request (or inside an inexpensive time following an extension), the MACs,
RACs and ZPICs/UPICs shall deny the claim in full or in part as not affordable and essential.
Ambi - ANS-both
Amendments, corrections and Delayed Entries in Medical Documentation - ANS-All offerings
furnished to beneficiaries are anticipated to be documented in the scientific file at the time
they're rendered
The MACs, Cert, Recovery Auditors, and ZPICs shall NOT take into account any entries that do
no observe the standards indexed in section B, even supposing such exclusion could result in a
claim denial. (Example: They shall not keep in mind undated or unsigned entries handwritten
inside the margin of a report. They shall exclude these entries from attention.)
aniso- - ANS-unequal
Anterior or ventral - ANS-At or close to the front floor of the body
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANS-Any gadgets or services
Anti-Kickback Statute (forty two US SS 1320a-7b (b) - what it applies to... - ANS-All Federal
Health Care Programs
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANS-False Claims act
liability
Civil monetary consequences and software exclusions
Potential $50,000 CMP/violation
