CCT Government Audits and RACs 3

Question 1

The Comprehensive Error Rate Testing (CERT) program is designed to measure which of the following?

Accepted Answer

The Medicare fee-for-service improper payment rate

Answer

CERT measures the Medicare fee-for-service improper payment rate by reviewing a random sample of paid claims each year.

Question 2

A Zone Program Integrity Contractor (ZPIC) differs from a RAC primarily because ZPICs focus on:

Accepted Answer

Fraud investigations and law enforcement referrals

Answer

ZPICs (now largely succeeded by UPICs) are focused on investigating suspected fraud and can refer cases to law enforcement, unlike RACs which focus on payment accuracy.

Question 3

Which of the following best describes an 'automated review' conducted by a RAC?

Accepted Answer

A claim review based solely on data analysis without requesting medical records

Answer

Automated reviews use claims data and logic edits to identify clear payment errors without requiring the provider to submit medical records.

Question 4

Under the RAC program, how are RAC contractors typically compensated?

Accepted Answer

Contingency fee based on improper payments identified

Answer

RACs are paid on a contingency fee basis, receiving a percentage of the overpayments collected and underpayments identified.

Question 5

A provider receives a RAC Additional Documentation Request (ADR). What is the maximum number of medical records a RAC can request from a single provider within a 45-day period?

Accepted Answer

Varies by provider type and size

Answer

CMS establishes ADR limits based on provider type and claim volume to prevent administrative burden, and these limits vary accordingly.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Government Audits and RACs 3