Champion's Exam

1.

1 point

What does the Stark Law ban?

Billing fraudulent claims.

Reporting medically unnecessary services.

Self-referrals to designated health services.

Unbundling services.

2.

1 point

What is CoP?

Commercial Programs

Medicaid's Coordination of Physician Groups

Medicare's Conditions of Participation

TriCare's Compliance of Physicians Guidance

3.

1 point

In a Corporate Integrity Agreement (CIA), does the OIG specify the Independent Review Organization to be used?

No; the OIG does not specify the IRO to be used, but does retain the right to notify the provider if they must select a new IRO.

Yes; the CIA will identify five IROs that can be used for the CIA Review.

No; the OIG does not have any input on the IRO used under any circumstance.

Yes; the specific IRO will be named in the CIA.

4.

1 point

What is one of the differences between the Stark Law and the Anti-Kickback law?

No intent must be proven for the Anti-Kickback law; the Stark law requires proof of intention.

No intent must be proven for the Stark law; the Anti-Kickback law requires proof of intention.

The Stark law refers to fraudulent billing; the Anti-Kickback law refers to remuneration for self referrals.

The Anti-Kickback law refers to fraudulent billing; the Stark law refers to remuneration for self referrals.

5.

1 point

A provider received a demand letter from the OIG initiating a Civil Monetary Penalty. The provider does not agree with the assessment from the OIG. What should the provider do?

Send a letter to the OIG outlining further details and send supporting evidence.

Gather the supporting evidence of innocence and take it to federal court.

Leave it alone, the OIG will find the assessment is incorrect when they come investigate further.

Request a hearing before an HHS ALJ.

6.

1 point

The OIG Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue during the next fiscal year and beyond. What factor is NOT considered when evaluating proposals for the Work Plan?

TriCare payments as a result of military war-related accidents.

Work to be performed in collaboration with partner organizations’ management’s actions to implement our recommendations from previous reviews.

Requests made or concerns raised by Congress, HHS management, or the Office of Management and Budget.

Mandatory requirements for OIG reviews, as set forth in laws, regulations, or other directive.

7.

1 point

What is the size of a Discovery Sample under a CIA?

10 sampling units

50 sampling units

100 sampling units

25 sampling units

8.

1 point

What is the penalty for violating the False Claims Act (FCA)?

$5,500-$10,000 per claim plus three times the amount of damages.

$5,500-$11,000 per claim plus three times the amount of damages.

$5,000-$11,000 per claim plus three times the amount of damages.

$5,000-$10,000 per claim plus three times the amount of damages.

9.

1 point

What is a Qui Tam Relator?

A person assigned to investigate accusations of fraudulent billing.

The defendant in a Qui Tam case.

A person who brings a civil action for a violation for him-/herself and for the U.S. Government.

The employer of the defendant in a Qui Tam case.

10.

1 point

What can a provider do if he or she disagrees with a demand letter sent as a result of a Recovery Audit?

Submit a discussion period request within 120 days of the date of the demand letter.

Submit a discussion period request within 15 days of the date of the demand letter.

Submit a request for review to the MAC within 120 days from the date of the demand letter.

Submit a request for review to the MAC within 15 days from the date of the demand letter.

11.

1 point

You audit a provider who is consistently reporting multiple units of CPT code 11042. What references can you use to show the provider multiple units of CPT code 11042 is not allowed and explain how it should be reported?

HCPCS codebook and NCCI edits.

CPT codebook and MUE table.

CPT codebook and NCCI edits.

MUE table only.

12.

1 point

What is another name for the Federal False Claims Act (FCA)?

Lincoln Law

Kennedy-Kassebaum Law

Stark Law

Operation Restore Trust

13.

1 point

The FCA allows for reduced penalties if the person in violation self-discloses if which conditions exist?

All of the choices

The person furnishes all information about the violation within 30 days after which the defendant first obtained the information.

The person fully cooperates with the investigation.

There is no additional criminal prosecution, civil action, or administrated action with the respect to the violation.

14.

1 point

A Qui Tam Relator may receive what type of award for bringing a case in which the government intervenes?

10-15 percent of the money recovered

15-25 percent of the total claim amount

15-25 percent of the money recovered

10-15 percent of the total claim amount

15.

1 point

In the NCCI edits, what does modifier indicator one represent?

The NCCI edit is not in effect.

A modifier may be used to bypass the edits if the documentation supports the modifier.

Modifiers are not applicable to the edits.

A modifiers is not allowed to bypass the NCCI edits.

16.

1 point

When a provider is excluded under the Exclusions Statute, what must he or she do at the end of the exclusionary period?

The provider is automatically reinstated.

The provider must apply for reinstatement.

The provider cannot be reinstated once excluded.

The provider must apply for a group provider number.

17.

1 point

Based on the compliance program guidance documents by the OIG, what should be documented when non-compliant conduct is found?

date of the incident, date of termination of the employee in non-compliance.

date of the incident, date the OIG received the report on the investigation.

date of incident, name of the reporting party, name of the person responsible for taking action, follow-up action taken.

action found to be non-compliant, date the employee's name was reported to the OIG.

18.

1 point

Which CCM indicator allows a modifier to be appended to bypass an NCCI edit?

1

0

9

2

19.

1 point

In the NCCI edits, what does modifier indicator nine represent?

A modifier may be used to bypass the edits if the documentation supports the modifier.

A modifiers is not allowed to bypass the NCCI edits.

Only modifier 59 can be used to bypass the edit.

Modifiers are not applicable to the edits, the NCCI edit is not in effect.

20.

1 point

When non-compliance is identified, what does the OIG recommended?

Take disciplinary action and document the date of the incident, name of the reporting party, name of the person responsible for taking action, and the follow-up action taken.

Take disciplinary action and document the date of the incident, name of the person responsible for taking action, the follow-up action taken, and a list of claims that were affected by the action.

Immediately terminate employment for the party found in non-compliance, regardless of the severity of the offense, document the date of the termination, file a corrected claim on all claims affected.

Continue to watch the employee in non-compliance until the incidents meet a federal level before taking action.

21.

1 point

What is the definition of abuse?

an action that results in unnecessary costs to a Federal health care program, either directly or indirectly

reporting the submission of false claims

making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal health care program

practicing medicine while on the exclusions list of the OIG

22.

1 point

What is the maximum penalty the OIG may seek for fraudulent claims?

$15,000 per item or service

$10,000 per item or service

$10,000 per item or service plus three times the amount of over-payments

$15,000 per item or service plus three times the amount of over-payments

23.

1 point

Recovery auditors may perform three types of reviews. What is an automated review?

Review based solely on the submitted claims and regulatory guidelines. No medical records are needed.

Medical records are required for the review.

Review based on data and potential human review of a medical record or other documentation.

Review is based solely on denials received.

24.

1 point

The OIG Work Plan is divided into seven parts. Which option is a part of the OIG Work Plan most applicable to physician services?

Corporate Integrity Agreements

Medicare Part A and Part B

Public Health Reviews

Human Services Reviews

25.

1 point

A Corporate Integrity Agreement (CIA) has seven core elements. Which option is NOT one of the core elements?

Provide an implementation report and annual reports to OIG on the status of the entity's compliance activities.

Develop written standards and policies.

Hire an OIG employee to oversee the compliance efforts.

Restrict employment of ineligible persons.

26.

1 point

Recovery auditors may perform three types of reviews. What review requires medical records?

Semi-Automated

Independent

Automated

Complex

27.

1 point

What program is provided by the OIG to assist in random selection of charts for a Discovery Sample?

The OIG provides an on-site investigator to randomly select the charts for the Discovery Sample.

The OIG recommends using Excel for statistical sampling.

The OIG does not have a program to assist in random sampling.

The OIG provides a statistical sampling program called RAT-STATS.

28.

1 point

What rights does a provider have if he/she disagrees with a demand letter sent by the OIG?

The provider can only respond to the demand letter with payment.

The provider can send in supporting documentation for the claims to the OIG for review by certified mail.

The provider can choose to self-disclose once a demand letter has been received.

The provider can request a hearing before an ALJ in the HHS.

29.

1 point

What is a semi-automated review?

A review based on electronic data examined from submitted claims but electively supported by medical records sent by the provider.

A review based on tips sent in from internal informants.

A review based on electronic data examined from submitted claims.

A review based on complete medical records review due to lack of a Medical Policy being in place.

30.

1 point

CMS has two sets of Evaluation and Management Documentation Guidelines, 1995 and 1997. Which set is used by physicians for office visits?

1997 E/M Documentation Guidelines

1995 E/M Documentation Guidelines

The practice may use 1995 or 1997 E/M Documentation Guidelines for each E/M visit; whichever is most advantageous for that visit.

The practice must choose either the 1995 or 1997 E/M Documentation Guidelines for the entire practice.