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

CMS administers the RAC program and contracts with private auditors to identify improper Medicare and Medicaid payments.

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

RACs are generally limited to a 3-year look-back period from the date the claim was paid.

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

The discussion period allows providers to submit additional documentation or discuss findings with the RAC before a formal demand is issued.

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

Complex reviews involve a clinical review of medical records and are used when automated data analysis alone cannot confirm improper payment.

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

Providers have 120 days from receipt of the initial determination (demand letter) to file a redetermination request at Level 1 of the Medicare appeals process.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Government Audits and RACs 2