Deck 14: Recovery Audit Contractors

Question 1

Once an improper payment is identified, the RAC would contact the provider and notify them of an overpayment that they received. They would look to collect that amount from the provider, or an underpayment that the provider received from CMS and pay that amount to the provider. This process is called:

A) Automated Review.
B) Retrospective Review.
C) Prospective Review.
D) Complex Review.

Answer 1

A

Question 2

The central part of the __________________________ is to request the medical records for the patient's stay that is in question. The medical records will assist the RAC in determining if there was an overpayment or underpayment.

A) Automated Review
B) Retrospective Review
C) Prospective Review
D) Complex Review

Answer 2

D

Question 3

The Third Level of Appeal is established when at least _____ remains in controversy following a Qualified Independent Contractor (QIC) decision. A request for reconsideration through an Administrative Law Judge (ALJ) hearing must be filed within 60 days of receipt of the reconsideration decision.

A) $120
B) $140
C) $160
D) $180

Answer 3

B

Question 4

The Fourth Level of Appeal is when an organization or party is unhappy with the ALJ decision and may request a review by the Appeals Council. This request must be submitted within ____ days of receipt of the ALJ's decision and must specify the issues and findings that are being contested.

A) 30
B) 60
C) 90
D) 120
E) None of these is correct.

Question 5

Since the inception of the Comprehensive Error Rate Testing Program (CERT), CMS has reduced improper payments from 9.8% in 2003 to 3.9% in 2007.

Question 6

This RAC program was designed to establish whether or not this type of program would be a cost-effective means of adding resources to determine if correct payments were being made from Medicare to various providers and suppliers.

Question 7

Most importantly, RAC contractors are paid via a contingency fee that is based on the amount of improper payments that they correct for both overpayments and underpayments.

Question 8

The goal of the program is that, even with paying a contingency fee to the RAC auditors, the integrity of the Medicare Trust Funds would be maintained. CMS, during the demonstration phase of this project, committed to addressing some concerns raised along with identifying successes and opportunities for improvement.