AABB correct answer: American Association of Blood Banks;
one of six CMS- approved accreditation organizations
Abuse correct answer: Improperly, and often unknowingly,
violating regulations
ALJ hearing correct answer: The third level of Medicare appeal;
the amount in controversy threshold for 2012 is $130
American Association of Blood Banks correct answer: AABB;
one of six CMS – approved accreditation organizations.
American Osteopathic Association correct answer: AOA; one
of six CMS – approved accreditation organizations
American Society of Histocompatibility and Immunogenetics
correct answer: ASHI; one of six CMS – approved accreditation
organizations
Anti-Kickback Statute correct answer: The Act that makes it a
criminal offense to knowingly and willfully offer, pay, solicit, or
receive any remuneration for referrals of items or services
reimbursable by a federal healthcare program
AOA correct answer: American Osteopathic Association; one
of six CMS – approved accreditation organizations
Appeals Council Review correct answer: The fourth level of
appeal; which can be requested if the provider is not satisfied
with the Administrative Law Judge’s decision
ASCA correct answer: Administrative Simplification
Compliance Act
ASHI correct answer: American Society of Histocompatibility
and Immunogenetics; one of six CMS – approved accreditation
organizations
Automated review correct answer: A RAC review using various
types of analytics to identify improper payments; usually done
without a human review of the medical records
CAP correct answer: College of American Pathologists; one of
six CMS – approved accreditation organizations
CERT correct answer: Comprehensive Error Rate Testing
program instituted by CMS to monitor and calculate the
accuracy and error rates for all MAC’s and to monitor the
accuracy of Medicare payments to FIs, carriers, and DMERCs
Certificate of Provider Performed Microscopy correct answer:
The CLIA certificate issued to a laboratory in which a physician,
mid-level practitioner, or dentist performs specific microscopy
procedures during the course of a patient’s visit
Certificate of Accreditation correct answer: COA; the CLIA
certificate issued to a laboratory on the basis of the laboratory’s
accreditation by an accreditation organization approved by CMS
Certificate of Compliance correct answer: COC; the CLIA
certificate issued to a laboratory once the State Department of
Health conducts an on-site survey/ inspection and determines
that the laboratory is compliant with all applicable CLIA
requirements
Certificate of Registration correct answer: The CLIA certificate
issued to allow a laboratory to conduct nonwaived testing until
the laboratory is surveyed to determine its compliance with the
CLIA regulations
Certificate of Waiver correct answer: COW; the CLIA
certificate issued to a laboratory that performs only waived tests
-“simple laboratory examinations and procedures that have an
insignificant risk of an erroneous result”
CIA correct answer: Corporate Integrity Agreement -the
agreement that spells out the integrity measure required of a
provider that has engaged in serious misconduct but is being
allowed to continue participating in the healthcare programs, or
Central Intelligence Agency
CLIA correct answer: Clinical Laboratory Improvement
Amendment; the amendments that established quality standards
for all laboratory testing
CMP correct answer: Civil Monetary Penalties
CMS correct answer: Centers for Medicare and Medicaid
Services
CMS Central Office Alert correct answer: one of the five types
of Fraud Alerts; prepared by ZPIC if a scheme is about to be
publicized on a national level, the case involves patient abuse or
a large dollar amount , or the issue involves politically sensitive
testimony
COA correct answer: Certificate of Accreditation; the CLIA
certificate issued to a laboratory on the basis of the laboratory’s
accreditation by an accreditation organization approved by CMS
COC correct answer: Certificate of Compliance; the CLIA
certificate issued to a laboratory once the State Department of
Health conducts an on-site survey /inspection and determines
that the laboratory is compliant with all applicable CLIA
requirements
COLA correct answer: Commission on Office Laboratory
Accreditation; one of six CMS-approved accreditation
organizations
College of American Pathologists correct answer: CAP; one of
six CMS- approved accreditation organizations
Commission on Office Laboratory Accreditation correct answer:
COLA; one of six CMS-approved accreditation organizations