HIM 370 Exam 1 2025/2026 Exam
Questions Marking Scheme New Update
| A+ Rated
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)
1
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, 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
What will CMS do to determine if the state beneficiaries are actually
eligible? - 🧠ANSWER ✔✔initiate audits
2
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
Questions Marking Scheme New Update
| A+ Rated
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)
1
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, 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
What will CMS do to determine if the state beneficiaries are actually
eligible? - 🧠ANSWER ✔✔initiate audits
2
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
