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What are the provisions of the False Claims Act in healthcare reimbursements?
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- What is the impact of the Anti-Kickback Statute on healthcare reimbursement and referralsA physician asks the medical biller to change the date of service on a Medicare claim because it has passed the timely filing limit and was not previously submitted for payment. Is this fraud or abuse if the claim is then submitted? Why?Why do insurance companies practice things like restricting provider choice, gatekeeping, and pre-authorization?
- The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. How can a physician get around the Physician Self-Referral Law?What is the meaning of tort reform? Question 36 options: a) Prospective immunity for hospitals from excess liability because of charitable acts b) Revision of transfusion-associated litigation to include licensed registered nurses as defendants c) Protection of specialty practices from punitive or excessive awards by state legislatures d) None of the aboveWhat is the difference in the reimbursement cycle among long-term care facilities as compared to most other healthcare facilities?
- Who would be impacted by such events claims production and claims submission in healthcare?What are two ways a healthcare provider could violate the HIPAA law, and what are alternative actions the healthcare provider could use to protect client confidentiality?The difference between a remittance advice (RA) and an explanation of benefits (EOB) is: The RA goes to the provider only and includes payment information. The EOB goes to the provider. The RA is sent to the patient and includes payment information. The EOB contains payment information.
