CCT - Certified Compliance Technician Government Audits and RACs Questions and Answers

Question 1

A hospital receives a letter from a Recovery Audit Contractor (RAC) that requests medical records for 15 inpatient stays to validate the medical necessity of the admissions.
This type of review is known as a:

Accepted Answer

Complex review

Answer

Pre-payment review

Answer

Automated review

Answer

CERT review

Question 2

What is the primary mission of the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program?

Accepted Answer

To identify and correct improper Medicare payments after they have been made.

Answer

To process and pay Medicare claims for a specific geographic region.

Answer

To measure the national Medicare Fee-for-Service improper payment rate.

Answer

To conduct pre-payment reviews on providers with unusual billing patterns.

Question 3

Which of the following is a key difference between a Recovery Audit Contractor (RAC) and a Medicare Administrative Contractor (MAC)?

Accepted Answer

RACs are paid on a contingency fee basis for collected overpayments, while MACs are not.

Answer

RACs are government agencies, while MACs are private companies.

Answer

RACs conduct post-payment reviews, while MACs are only responsible for pre-payment claim processing.

Answer

RACs can review all claim types, whereas MACs are limited to Part A claims.

Question 4

A physician's office receives a final demand letter from a RAC for an overpayment. The office disagrees with the finding. What is the first level of the five-level Medicare appeals process the office must initiate?

Accepted Answer

Redetermination by a Medicare Administrative Contractor (MAC)

Answer

Reconsideration by a Qualified Independent Contractor (QIC)

Answer

Hearing before an Administrative Law Judge (ALJ)

Answer

Review by the Medicare Appeals Council

Question 5

A compliance technician is assisting with a documentation request from the Comprehensive Error Rate Testing (CERT) program. What is the primary purpose of this type of government audit?

Accepted Answer

To measure the overall improper payment rate in the Medicare FFS program.

Answer

To recover improper payments made to the specific provider under review.

Answer

To identify and prosecute instances of healthcare fraud.

Answer

To review and approve new areas for RACs to investigate.

Question 6

A hospital is preparing for potential RAC audits. The scope of a RAC's post-payment review includes the identification of which of the following?

Accepted Answer

Both overpayments and underpayments

Answer

Overpayments only

Answer

Underpayments only

Answer

Only claims with incorrect CPT codes

A hospital receives a letter from a Recovery Audit Contractor (RAC) that requests medical records for 15 inpatient stays to validate the medical necessity of the admissions.This type of review is known as a:

A hospital receives a letter from a Recovery Audit Contractor (RAC) that requests medical records for 15 inpatient stays to validate the medical necessity of the admissions.
This type of review is known as a: