Audit Trail

Auditing

Law where definition of medical necessity can be found

Medical necessity

Process of determining if healthcare services performed on a patient is necessary

Utilization management provides information on ___________ and __________ ______________ of a healthcare organization.

Organization that requires implementation of a utilization management program in acute care hospitals to ensure accreditation

Three functions of utilization management are:

Retrospective utilization review

Admission review

An __________ __________ can show which employee accessed an electronic health record (EHR) and what operations he/she performed on it.

Upcoding

Which agency defines the essential elements of a Corporate Compliance program?

Unbundling

True/False: Compliance programs are required to include complete and accurate coding.

Three types of medically unnecessary services are:

False Claim Act (FCA)

This law authorizes investigations, audits, and evaluations of health care fraud

This agency is authorized to conduct healthcare fraud and abuse investigations in Medicare, Medicaid, and other programs in Health and Human Services (HHS)

True/False: Audit trails are not very important because they cannot assist with preserving data confidentiality and integrity.

PEPPER

Senior Medicare Patrol