CCT Government Audits and RACs 4

Question 1

A Unified Program Integrity Contractor (UPIC) was created to replace which two legacy contractor types?

Accepted Answer

ZPICs and PSCs

Answer

UPICs consolidated the functions of Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) into a single contractor.

Question 2

What is the primary purpose of the OIG Work Plan in the context of government audits?

Accepted Answer

To announce planned audits, reviews, and studies for the coming fiscal year

Answer

The OIG Work Plan outlines the audits, evaluations, and inspections the OIG intends to conduct, allowing compliance officers to proactively assess risk areas.

Question 3

Statistical sampling and extrapolation in a Medicare audit means that:

Accepted Answer

Findings from a reviewed sample are projected to estimate overpayments across the universe of similar claims

Answer

Extrapolation applies an error rate found in a statistical sample to the entire universe of similar claims, potentially resulting in large overpayment demands from a small sample.

Question 4

Under which condition may a Medicare contractor NOT use extrapolation to expand overpayment findings?

Accepted Answer

When there is no sustained or high level of payment error and no prior education attempts

Answer

CMS policy limits the use of extrapolation to situations involving a sustained or high level of payment error or where education has failed to correct billing problems.

Question 5

Which of the following is a key difference between a MAC post-payment review and a RAC audit?

Accepted Answer

RACs are paid on contingency; MACs are paid a flat administrative fee

Answer

The key structural difference is compensation: RACs receive a contingency fee for identified improper payments, while MACs are paid an administrative fee regardless of audit outcomes.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Government Audits and RACs 4