CPCO Chapter 11 EXAM - RACs,
ZPICs, MICs, PSCs, MFCUs Exam 2025
Questions and Answers
Can providers request an extension to provide records requested by an auditor if there is
a problem meeting the deadline? - ....ANSWER ...-Yes, by calling the requestor
and explaining the reason for delay
Response Feedback:
Rationale: If there is a problem meeting the deadline, call the requestor to explain the
reason for the delay and ask for an extension.
What established the Medicaid Integrity Program? - ....ANSWER ...-Section 1936
of the Social Security Act
Response Feedback:
Section 1936 of the Social Security Act created the Medicaid Integrity Program (MIP)
and directed the CMS to enter into contracts to review Medicaid provider actions, audit
claims, identify overpayments, and educate providers and others on Medicaid program
integrity issues.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,The Compliance Officer asked the Billing Manager at Orange Hospital how many days
they had to send CERT contractor documentation. The Billing Manager said that
documentation had to be sent to the CERT contractor within: - ....ANSWER ...-75
days
Response Feedback:
75 days. The CERT documentation contractor may request medical records from the
provider or supplier who submitted the claim:
For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services), additional
documentation requests are also made to the referring provider who ordered the item or
service.
If no documentation is received within 75 days of the initial request, the claim is
classified as a "no documentation" claim and counted as an error.
If documentation is received after 75 days of the initial request (late documentation),
CERT will still review the claim.
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)? -
....ANSWER ...-Limited to investigating Medicaid provider fraud
Response Feedback:
Rationale: The jurisdiction of the Medicaid Fraud Control Units (MFCUs) is limited to
investigating and prosecuting Medicaid provider fraud. The MFCUs have prosecuted
individual providers such as physicians, dentists, and mental health professionals.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, ZPICs target both the _______ of a claim and _____ errors - ....ANSWER ...-
medical necessity, coding
Response Feedback:
ZPICs target both the medical necessity of a claim (e.g., whether it was covered
according to national or local coverage determinations and Medicare guidelines) and
coding errors (e.g., DRG and E/M services up-coding). ZPICs are responsible for
ensuring the integrity of all Medicare-related claims under Parts A and B (hospital,
skilled nursing, home health, provider and DME claims), Part C (Medicare Advantage
health plans), Part D (prescription drug plans), and coordination with the Medicare-
Medicaid Data Match Program (Medi-Medi).
Which of the following is NOT TRUE regarding how improper payments are
categorized? - ....ANSWER ...-Billed Based on Time
Response Feedback:
CMS and Contractors categorize improper payments as follows: No Documentation;
Insufficient Documentation; Medical Necessity; Incorrect Coding and Other.
What is NOT a typical way that providers try to defraud Medicaid? -
....ANSWER ...-Billing under several NPI's at a time
Response Feedback:
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
ZPICs, MICs, PSCs, MFCUs Exam 2025
Questions and Answers
Can providers request an extension to provide records requested by an auditor if there is
a problem meeting the deadline? - ....ANSWER ...-Yes, by calling the requestor
and explaining the reason for delay
Response Feedback:
Rationale: If there is a problem meeting the deadline, call the requestor to explain the
reason for the delay and ask for an extension.
What established the Medicaid Integrity Program? - ....ANSWER ...-Section 1936
of the Social Security Act
Response Feedback:
Section 1936 of the Social Security Act created the Medicaid Integrity Program (MIP)
and directed the CMS to enter into contracts to review Medicaid provider actions, audit
claims, identify overpayments, and educate providers and others on Medicaid program
integrity issues.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,The Compliance Officer asked the Billing Manager at Orange Hospital how many days
they had to send CERT contractor documentation. The Billing Manager said that
documentation had to be sent to the CERT contractor within: - ....ANSWER ...-75
days
Response Feedback:
75 days. The CERT documentation contractor may request medical records from the
provider or supplier who submitted the claim:
For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services), additional
documentation requests are also made to the referring provider who ordered the item or
service.
If no documentation is received within 75 days of the initial request, the claim is
classified as a "no documentation" claim and counted as an error.
If documentation is received after 75 days of the initial request (late documentation),
CERT will still review the claim.
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)? -
....ANSWER ...-Limited to investigating Medicaid provider fraud
Response Feedback:
Rationale: The jurisdiction of the Medicaid Fraud Control Units (MFCUs) is limited to
investigating and prosecuting Medicaid provider fraud. The MFCUs have prosecuted
individual providers such as physicians, dentists, and mental health professionals.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, ZPICs target both the _______ of a claim and _____ errors - ....ANSWER ...-
medical necessity, coding
Response Feedback:
ZPICs target both the medical necessity of a claim (e.g., whether it was covered
according to national or local coverage determinations and Medicare guidelines) and
coding errors (e.g., DRG and E/M services up-coding). ZPICs are responsible for
ensuring the integrity of all Medicare-related claims under Parts A and B (hospital,
skilled nursing, home health, provider and DME claims), Part C (Medicare Advantage
health plans), Part D (prescription drug plans), and coordination with the Medicare-
Medicaid Data Match Program (Medi-Medi).
Which of the following is NOT TRUE regarding how improper payments are
categorized? - ....ANSWER ...-Billed Based on Time
Response Feedback:
CMS and Contractors categorize improper payments as follows: No Documentation;
Insufficient Documentation; Medical Necessity; Incorrect Coding and Other.
What is NOT a typical way that providers try to defraud Medicaid? -
....ANSWER ...-Billing under several NPI's at a time
Response Feedback:
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
