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Frequently Asked Questions About AHFI: |
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| Q. |
What is an AHFI? |
| A. |
AHFI is a unique professional designation granted by the National Health Care Anti-Fraud Association to individuals who meet certain qualifications related to professional experience, specialized training, formal education and demonstrated knowledge in the detection, investigation and/or prosecution of health care fraud. |
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| Q. |
How many training hours must I have to pursue the AHFI® designation? |
| A. |
If you are applying for the Professional Credential Process for Senior Staff you must have a minimum of 90 hours of health care anti-fraud training in the 4 years preceding application. If you are applying for the Examination-based Process you must have a minimum of 75 hours of health care anti-fraud training in the 4 years preceding application. |
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| Q. |
What is professional experience in health care fraud detection, investigation or prosecution? |
| A. |
Professional experience in health care fraud detection, investigation or prosecution can be defined as any work-related experience related to the actual investigation of health care fraud, or engaging in detection activities where the intent is to uncover health care fraud, or the prosecuting of health care fraud cases. The developing of anti-fraud software and products to enhance the detection and prevention of health care fraud is also acceptable. Auditing activities, where the individual is examining claims for the purpose of uncovering of billing and claims errors is not considered an investigation or detection activity, unless when a potential fraud scheme is uncovered, the detection and investigation of the fraud happens in the audit department, and not referred to the SIU or another federal or state agency.
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| Q. |
What types of training and education experience will count towards my AHFI® credits? |
| A. |
NHCAA will accept any training program whose learning objectives and educational goal would enhance the health care fraud investigation, detection or prosecution skills of the investigator. Acceptable training not specific to health care fraud can include coding classes, software (anti-fraud or excel) classes, classes from other health care organizations designed to raise awareness of health care products or terminology. Training can come from a number of sources, including other professional associations, user group meetings, software vendors, and internal training. To receive credit for training activities attended, the applicant must submit, at the time of application, or at the time of AHFI® renewal, an agenda from the program indicating topics covered, time per topic and some type of evidence of course completion. |
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| Q. |
How do I calculate training hours? |
| A. |
If attending NHCAA in-person trainings, a certificate of completion stating the number of Continuing Professional Education unites (CPEs) earned will be available at the close of the conference. The NHCAA Web site lists the number of CPEs awarded for all other online learning, like the Online NETS and NHCAA Audio Conferences. These credits are earned by attending the event, and then completing and submitting an attestation of completion form. NHCAA keeps records of all NHCAA issued training program attendance.
Hours for non-NHCAA training will be determined by the NHCAA staff, based on the submission of the necessary documentation. |
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| Q. |
How do I report training hours? |
| A. |
For applicants, training hours and supporting documentation needs to be submitted with the AHFI® application. For AHFI® renewals, any outside training hours and supporting documentation should be submitted with the AHFI® renewal financial payment. |
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| Q. |
What topics does the AHFI Examination cover? |
| A. |
The Examination deals with the Nature and Scope of the US Health Care System; Medical/Health Insurance Terminology; Types of Fraud and Fraud Indicators; Detection/Investigation Skills and Knowledge; and Legal/Statutory/Regulatory Aspects of Health Care Fraud. |
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| Q. |
Is there a study guide for the Examination? |
| A. |
There is no study guide offered per se. The NHCAA Accreditation Committee, the governing body that sets the criteria for applying for Accreditation, believes that those individuals who are routinely involved in health care fraud detection, investigation and/or prosecution, should be able to pass the Examination based on their professional experience, training and education. Therefore, the Committee has decided not to offer a formalized study guide, but offer a Glossary of Terms to be used for study, an AHFI® Prep Course that draws from the specific sections of the exam, and provides the NHCAA Fraud Fighter’s Handbook, a useful tool to study best practices in fraud investigation.
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