CMRT Revenue Cycle Management 5

Question 1

Which recovery audit program is specifically authorized to identify Medicare overpayments and underpayments?

Accepted Answer

Recovery Audit Contractor (RAC)

Answer

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?

Accepted Answer

Submit a redetermination request to the MAC within 120 days

Answer

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?

Accepted Answer

Determining the correct order and limits of payment when a patient has more than one health plan

Answer

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?

Accepted Answer

$13,000 (adjusted for inflation)

Answer

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?

Accepted Answer

-50

Answer

Modifier -50 is used to indicate that the identical procedure was performed on both sides of the body during the same operative session.

(CMRT) Certified Medical Records Technician Practice Test

(CMRT) Certified Medical Records Technician Practice Test

CMRT Revenue Cycle Management 5