Revenue Cycle Management Flashcards
7 cards from real AHIMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle Management flashcards as text
What is the primary purpose of an Advance Beneficiary Notice (ABN)?
Answer: To inform a Medicare beneficiary that a service may not be covered and they may be liable for payment
An ABN is issued to Medicare patients before providing a potentially non-covered service, shifting financial liability to the patient if Medicare denies the claim.
Under the False Claims Act, which action creates civil monetary liability?
Answer: Knowingly submitting false or inflated claims to a federal healthcare program
The False Claims Act imposes civil penalties and treble damages for knowingly submitting false or fraudulent claims to government healthcare programs.
What is the primary function of a Recovery Audit Contractor (RAC) in Medicare?
Answer: Identifying and recovering improper Medicare payments through post-payment audits
RACs are CMS-contracted entities that perform post-payment audits to identify overpayments and underpayments in the Medicare program.
The Stark Law (Physician Self-Referral Law) primarily prohibits:
Answer: Physicians referring Medicare/Medicaid patients for designated health services to entities in which they have a financial relationship
Stark Law prohibits physicians from referring patients to entities for designated health services when the physician or an immediate family member has a financial interest in that entity.
Which federal office publishes the annual Work Plan outlining healthcare fraud and abuse enforcement priorities?
Answer: Office of Inspector General (OIG)
The OIG Work Plan is published annually and identifies audits, evaluations, and investigations the OIG plans to conduct related to federal healthcare programs.
The Anti-Kickback Statute (AKS) prohibits:
Answer: Offering, paying, soliciting, or receiving anything of value to induce referrals for federally reimbursed services
The AKS prohibits any remuneration exchanged to induce or reward referrals of items or services covered by federal healthcare programs.
Which element is a required component of an effective compliance plan per OIG guidance?
Answer: Written standards of conduct with internal monitoring and auditing processes
The OIG identifies seven elements of an effective compliance program, including written policies, training, internal auditing, and corrective action procedures.