HIM 370 EXAM 1 QUIZZES & ANS GRADED A+
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? Answer - CMS
what did CMS do to increase scrutiny of improper payments by Medicare part
A and B to hospitals? Answer - Created RAC (recovery audit contractor)
How far back can RAC go? Answer - 3 years from date of discharge
What did CMS develop and implement to focus on overpayments to
providers/hospitals from Medicaid? Answer - MIP (Medicaid Integrity
Program)
What did CMS do to indentify and investigate malicious fraud in 7 geographic
locations? 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 Answer - RAC
What may providers request from RAC on findings? Answer - education
who does the responsibility of proper payments from medicaid lie with?
Answer - each state
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? Answer - CMS
what did CMS do to increase scrutiny of improper payments by Medicare part
A and B to hospitals? Answer - Created RAC (recovery audit contractor)
How far back can RAC go? Answer - 3 years from date of discharge
What did CMS develop and implement to focus on overpayments to
providers/hospitals from Medicaid? Answer - MIP (Medicaid Integrity
Program)
What did CMS do to indentify and investigate malicious fraud in 7 geographic
locations? 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 Answer - RAC
What may providers request from RAC on findings? Answer - education
who does the responsibility of proper payments from medicaid lie with?
Answer - each state
