course hero which of the following is not an example of the financial benefits of acting as a

What is the last level of Medicare appeal?

The last level of Medicare appeal sends the appeal to federal district court for a final ruling. Quality Improvement Organizations (QIO) performs medical peer review of Medicare and Medicaid claims. The reviews include validity of hospital diagnosis and procedure code completeness, adequacy, and quality of care.

What is the BBA Act?

Balanced Budget Act of 1997 (BBA) excludes healthcare organizations convicted of healthcare related crimes from participating in Medicare programs. 10 years, permanent. The Balanced Budget Act of 1977 exclusion from Medicare includes: ____ years for a first offense.

What is the process of establishing an organizational culture that promotes the prevention, detection, and resolution of instances of conduct

Compliance. is the process of establishing an organizational culture that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal, state, or private payer healthcare program requirements or the healthcare organization's ethical and business policies. Compliance .

What is SOI in medical terms?

Severity of illness (SOI) is a type of supportive documentation reflecting objective clinical indicators of a patient illness (meaning the patient is sick enough to be at an identified level of care) and referring to the extent of physiological decompensation or organ system loss of function.

What is a medical condition that arises during an inpatient hospitalization?

is a medical condition that arises during an inpatient hospitalization (ex. a postoperative wound infection) Comorbidity. is a medical condition that coexists with the primary cause for hospitalization and affects the patient's treatment and length of stay (ex. a chronic condition like diabetes mellitus) Benchmarking.

What is the practice of using multiple codes to bill for the various individual steps in a single procedure?

Organizations, entities, and individuals can be penalized for: Unbundling. is the practice of using multiple codes to bill for the various individual steps in a single procedure rather than using a single code that includes all of the steps of the comprehensive procedure code. Unbundling.

What is intentional deception?

is the intentional deception or misrepresentation that an individual knows (or should know) to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person