1. WELCOME TO SEMINAR 4

2. RISKS TO THE MEDICAL OFFICE Fraud: An intentional deception or misrepresentation made by an individual who knows that the false information reported could result in a benefit to himself/herself or another person. Abuse: An incident or practice not consistent with sound medical, business, or fiscal practices, such as providing medically unnecessary care or care that does not meet the standards of care. NOT abuse when service IS Necessary.

3. The Fraud and Abuse Control Program was established by the government under: The Fraud and Abuse Control Program was established by the government under: HR3103 Subtitle A HR3103 Subtitle A Example of fraud? Example of fraud? Altering claims, over-billing, Over- utilization. NOT CREDIT BALANCES FOR PT. Altering claims, over-billing, Over- utilization. NOT CREDIT BALANCES FOR PT. The first fraud alert was issued in: 1988 The first fraud alert was issued in: 1988 Fraud alerts? Nursing home services, Waiver of co-pays, Joint venture arrangements Fraud alerts? Nursing home services, Waiver of co-pays, Joint venture arrangements

4. Under the Beneficiary Incentive Program, beneficiaries receive at least which of the following dollar amounts for reporting fraud? $100 Under the Beneficiary Incentive Program, beneficiaries receive at least which of the following dollar amounts for reporting fraud? $100 Is Your Practice Guilty of Fraud and Abuse? Is the service/supply necessary? Is the service/supply appropriate according to professionally recognized standards? Has a fair price been charged?

5. LEGISLATIONS AND ACTS In which year did antitrust laws begin to affect health care? 1975- cannot ruin another business etc In which year did antitrust laws begin to affect health care? 1975- cannot ruin another business etc Medicare and Medicaid Patient and Program Protection Act of 1987 http://www.netreach.net/~wmanning/fasum m.htm

6. The Patient Self-Determination Act came into effect in which year? 1991 The Patient Self-Determination Act came into effect in which year? 1991 http://www.legalhelpmate.com/health- care-directive-patient-act.aspx http://www.legalhelpmate.com/health- care-directive-patient-act.aspx http://www.legalhelpmate.com/health- care-directive-patient-act.aspx http://www.legalhelpmate.com/health- care-directive-patient-act.aspx Have to give pt notice of rights for end of life choices, need someone listed as contact. You can accept or refuse care. Have to give pt notice of rights for end of life choices, need someone listed as contact. You can accept or refuse care.

7. Which act provides for overtime worked? Which act provides for overtime worked? Fair Labor Standards Act Fair Labor Standards Act Which act was designed to protect the handicapped against discrimination? Which act was designed to protect the handicapped against discrimination? Vocational Rehabilitation Act Vocational Rehabilitation Act

8. The Food and Drug Administration is a division of ? Public Health Service The Food and Drug Administration is a division of ? Public Health Service Which act protects employees from benefits discrimination? Older Workers Benefit Protection Act. Which act protects employees from benefits discrimination? Older Workers Benefit Protection Act.

9. Preventing a Lawsuit Maintain accurate and neat records Have a risk management plan Have good rapport with patients Have prescription renewals policy in place Have respect for patients and their families Strive for good treatment outcomes Provide patient services based on accepted standards of care

10. Law and abortion: name of PCP is not required. Law and abortion: name of PCP is not required. OIG = Office of Inspector General. They don’t consider a Dr.’s relationship with a collection agency as a risk. OIG = Office of Inspector General. They don’t consider a Dr.’s relationship with a collection agency as a risk. hot line issues: most reported are: Conflict of interest, theft, injustice from admin. hot line issues: most reported are: Conflict of interest, theft, injustice from admin.

11. SOME MID TERM INFO NOT COVERED Dr. visits require a code, like other services. They all begin with 9929--. Go by level of time spent, new Pt. etc. Dr. visits require a code, like other services. They all begin with 9929--. Go by level of time spent, new Pt. etc. The following is one of the key factors in choosing an E&M code: Medical decision making (Evaluation and Management) The following is one of the key factors in choosing an E&M code: Medical decision making (Evaluation and Management) The 1995 definition of a detailed examination is: Extended exam of affected body area and other symptomatic systems The 1995 definition of a detailed examination is: Extended exam of affected body area and other symptomatic systems