Health Care Finance |25 Questions| With Correct Answers.

The _____ component of a compliance program will help to evaluate if individuals are properly carrying out their responsibilities and claims are submitted appropriately. A. auditing B. monitoring C. both A and B D. none of these are correct. {Ans: A. auditing}Difference between fraud and abuse {Ans: Abuse is when a healthcare provider does not follow good medical practice Fraud is an occurrence that someone intentionally falsies information}____ offers certification programs that are a subset of the accreditation product that it offers; these programs focus on the organizations that provide a specialty or a more specific line of care and not the comprehensive programs that other organizations provide. A. NCQA B. ACO C. MBO D. JCAHO {Ans: A. NCQA}Medicare will always pay secondary claims when Medicaid is the primary coverage plan. True False {Ans: False}The codes in the Office or Other Outpatient Services (99201-99205) section are for services provided in the office or in an outpatient or other ambulatory facility for a New or Established Patient. The patient is considered to be an outpatient until admitted to an inpatient setting in a healthcare facility. True False {Ans: True}All US citizens become Medicaid eligible on the