CMRT Revenue Cycle Management 5 — Questions and Answers
Question 1: Which recovery audit program is specifically authorized to identify Medicare overpayments and underpayments?
- Medicare Administrative Contractor (MAC)
- Recovery Audit Contractor (RAC) (Correct answer)
- Comprehensive Error Rate Testing (CERT)
- Zone Program Integrity Contractor (ZPIC)
Correct answer: Recovery Audit Contractor (RAC)
RAC auditors are authorized by CMS to identify improper Medicare payments—both overpayments and underpayments—on a contingency-fee basis.
Question 2: A provider receives a demand letter from Medicare requesting repayment of an alleged overpayment. What is the first formal step to dispute this finding?
- File a complaint with the OIG
- Submit a redetermination request to the MAC within 120 days (Correct answer)
- Request a hearing before an Administrative Law Judge (ALJ)
- Contact CMS Central Office directly
Correct answer: Submit a redetermination request to the MAC within 120 days
The first level of the Medicare appeals process is a redetermination request submitted to the MAC, which must be filed within 120 days of the initial determination.
Question 3: What does 'coordination of benefits (COB)' refer to in medical billing?
- Negotiating contracted rates with multiple payers simultaneously
- Determining the correct order and limits of payment when a patient has more than one health plan (Correct answer)
- Combining multiple encounters into one claim for efficiency
- Coordinating benefit packages for new employees during open enrollment
Correct answer: Determining the correct order and limits of payment when a patient has more than one health plan
COB rules establish the order in which payers are responsible for payment and prevent total reimbursement from exceeding 100% of the covered expense.
Question 4: Under the False Claims Act, what is the minimum civil penalty per false claim submitted to the federal government?
- $1,000
- $5,000
- $13,000 (adjusted for inflation) (Correct answer)
- $50,000
Correct answer: $13,000 (adjusted for inflation)
The False Claims Act imposes civil penalties of approximately $13,000–$26,000 per false claim (amounts adjusted periodically for inflation), plus three times the actual damages.
Question 5: Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally during the same operative session?
- -50 (Correct answer)
- -51
- -59
- -76
Correct answer: -50
Modifier -50 is used to indicate that the identical procedure was performed on both sides of the body during the same operative session.
Question 6: A facility's days in accounts receivable (DAR) is 52. Which situation would most likely cause this number to increase?
- Increased use of real-time eligibility verification
- A rise in claim denial rates requiring rework before resubmission (Correct answer)
- Implementation of an automated payment posting system
- A decrease in patient self-pay balances
Correct answer: A rise in claim denial rates requiring rework before resubmission
Higher denial rates mean claims must be corrected and resubmitted, delaying payment and increasing the average number of days receivables remain outstanding.
Question 7: Which of the following describes the role of a 'charge master' (CDM) in hospital revenue cycle management?
- A list of all approved ICD-10-CM diagnosis codes used by the facility
- A comprehensive list of all services, procedures, and supplies with their associated prices and billing codes (Correct answer)
- A payer fee schedule showing contracted reimbursement rates
- A report tracking physician productivity relative to billing targets
Correct answer: A comprehensive list of all services, procedures, and supplies with their associated prices and billing codes
The charge description master (CDM) is the facility's master price list that links each service or supply to its billing code (CPT/HCPCS) and internal charge amount.
CMRT Revenue Cycle Management 5
Which recovery audit program is specifically authorized to identify Medicare overpayments and underpayments?