HIM 370 Exam 1
Who conducts research on the effectiveness of various methods of health care management, treatment, and financing; is reponsible for assessing the quality of health care facilities and services; and establishes reimbursement policies for providers? Correct Answer: CMS
what did...
HIM 370 Exam 1
Who conducts research on the effectiveness of various methods of health care management, treatment,
and financing; is reponsible for assessing the quality of health care facilities and services; and establishes
reimbursement policies for providers? Correct Answer: CMS
what did CMS do to increase scrutiny of improper payments by Medicare part A and B to hospitals?
Correct Answer: Created RAC (recovery audit contractor)
How far back can RAC go? Correct Answer: 3 years from date of discharge
What did CMS develop and implement to focus on overpayments to providers/hospitals from Medicaid?
Correct Answer: MIP (Medicaid Integrity Program)
What did CMS do to indentify and investigate malicious fraud in 7 geographic locations? Correct Answer:
created ZPIC (zone program integrity contractor)
Who detects and corrects past and improper payments, can implement actions that will prevent future
improper payments, and reviews claims on a post-payment basis Correct Answer: RAC
What may providers request from RAC on findings? Correct Answer: education
who does the responsibility of proper payments from medicaid lie with? Correct Answer: each state
who is responsible for state oversight and accountability of Medicaid? Correct Answer: federal
government
who will check to make sure medicaid claims match what the plans have been reporting? Correct
Answer: CMS
What will CMS do to determine if the state beneficiaries are actually eligible? Correct Answer: initiate
audits
What will CMS do to reduce improper payments? Correct Answer: provide education
Whose primary goal is to identify cases of suspected fraud development and take immediate action?
Correct Answer: CMS
Who ensures trust fund monies are paid out appropriately and recoups mistaken payments? Correct
Answer: ZPIC (zone program integrity contractor)
Who would ZPIC report fraud to? Correct Answer: OIG
What happens if provider refuses to cooperate with ZPIC or is found to have committed malicious fraud
with intent? Correct Answer: revocation of certification
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