CCT Government Audits and RACs 2

Question 1

Which entity administers the Recovery Audit Contractor (RAC) program on behalf of CMS?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Office of Inspector General (OIG)

Answer

The Department of Justice (DOJ)

Answer

The Government Accountability Office (GAO)

Question 2

What is the maximum look-back period that a RAC can use when reviewing Medicare fee-for-service claims?

Accepted Answer

3 years

Answer

1 year

Answer

2 years

Answer

5 years

Question 3

A RAC identifies a claim as a potential overpayment but has not yet issued a demand letter. What is this stage called?

Accepted Answer

Discussion period

Answer

Automated review

Answer

Complex review

Answer

Extrapolation

Question 4

Which type of RAC review requires human review of medical records before an improper payment determination is made?

Accepted Answer

Complex review

Answer

Automated review

Answer

Semi-automated review

Answer

Statistical sampling review

Question 5

When a RAC issues an overpayment demand letter, within how many days must a provider file a redetermination request with the MAC to begin the appeals process?

Accepted Answer

180 days

Answer

30 days

Answer

60 days

Answer

120 days

Question 6

In the context of RAC audits, what does 'underpayment' mean?

Accepted Answer

An instance where Medicare paid less than it should have under the rules

Answer

A claim paid at a lower rate than the Medicare fee schedule

Answer

A payment made to an ineligible provider

Answer

A claim denied due to lack of medical necessity

Question 7

Which government program specifically targets Medicaid fraud, waste, and abuse through state-level audits, separate from the federal RAC program?

Accepted Answer

Medicaid RAC (MIC) program

Answer

ZPIC program

Answer

CERT program

Answer

MAC program