HIM 370 EXAM 1 QUESTIONS
WITH CORRECT ANSWERS
Who conducts research on the effectiveness of various methods of health care
management, treatment, and financing; is responsible 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 the 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 is responsible for state oversight and accountability of Medicaid? -
ANSWER federal government
who will check to make sure medicaid claims match what the plans have been
reporting? - ANSWER CMS
WITH CORRECT ANSWERS
Who conducts research on the effectiveness of various methods of health care
management, treatment, and financing; is responsible 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 the 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 is responsible for state oversight and accountability of Medicaid? -
ANSWER federal government
who will check to make sure medicaid claims match what the plans have been
reporting? - ANSWER CMS
