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Scenario Red Flag Test Assessment
Test:
Description:
Path:
Provider Compliance - Submission of Accurate Claims and Information > Billing - Patient not present > Billing for services not provided - Using phantom or deceased persons' names > Patient File Does Not Agree with Billing Records
Assessment
Test Detail
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)
1.
Test Performed
Yes
No
2.
Test performed by
3.
Test Work and Results
Findings
No Findings
4.
Red Flag Frequency
Frequent
Moderate
Infrequent
5.
Red Flag Risk
High
Moderate
Low
Audit Test Findings
Add Finding...
Finding
Type
Risk
Test finding
Fraud Suspect
Moderate
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Detail
Test finding was found through test
Risk
The risk of this finding is moderate
Management Response
This risk needs to be mitigated
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