What type of strategy helps providers avoid fraud allegations by ensuring accurate documentation?
Documentation strategies
Why is a clinical documentation integrity (CDI) program important?
Improves accuracy and prevents fraud/abuse
Which policies define medical necessity for services?
Local Coverage Determinations (LCDs)
What do LCD policies typically include?
Covered and non-covered diagnosis codes
Which sampling method gives every claim an equal chance of selection?
Simple random sampling
What system tracks turnaround time for release of information requests?
ROI tracking system
What tool helps visualize and understand a process step-by-step?
Flowchart
What agreement is imposed after fraud investigations by the OIG?
Corporate Integrity Agreement (CIA)
What is a key element of OIG compliance programs?
Written policies and procedures
Which area is considered high risk in internal audits?
Chargemaster accuracy
What are the core functions of a risk management program?
Risk identification, loss prevention, claims management
What is the main goal of coding compliance programs?
Prevent fraud and abuse accusations
What happens if an incident report is mentioned in the health record?
It becomes discoverable
What is the primary goal of a corporate compliance program?
Protect against legal penalties
What are incomplete records past a deadline called?
Delinquent records
What action should be taken if error rates exceed standards?
Corrective action
Billing brand name drugs but dispensing generics is an example of what?
Fraud
What should be done about late changes to transcribed reports?
Set policy for draft time limits
What tool identifies root causes of problems?
Fishbone diagram
Where can compliance officers find audit priorities annually?
OIG Work Plan
What is reasonable diligence in compliance?
Attempting to follow rules but failing
What data must be monitored per Joint Commission requirements?
Procedures, meds, blood use
Why conduct external audits?
Validate internal audits
What defines healthcare fraud?
Intentional misrepresentation for payment
