HIM 370 Exam 1 UPDATED ACTUAL
Exam Questions and CORRECT Answers
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
Exam Questions and CORRECT Answers
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
