Domain 4 CDIP notes Part 1 of 6 | Questions and Answers(A+ Solution guide)

Why hire Medicare Contractor Reviewers? - For Protection of Medicare Trust Fund. Who is 1st of 6 Medicare Contract Reviewers? - (MACs) Medicare Administrative Contractors Whos is 2nd of 6 Medicare Contract Reviewers? - (RACs) Recovery Auditor Contractors Who's 3rd of 6 Medicare Contractor Reviewers? - (CERTs) Comprehensive Error Rate Testing Contractors Who's 4th of 6 Medicare Contract Reviewers? - (SMRCs) Supplemental Medical Review Contractors Who's 5th of 6 Medicare Contract Reviewers? - (ZPICs) Zone Program Integrity Contractors Who's 6th of 6 Medicare Contract Reviewers? - (UPICs) Unified Program Integrity Contractor What are the MACs Responsible for? - Performed Medical Reviews of IPPS claims since 2008. What's the purpose of a medical Review? - Validates Medicare payments are made on claims that are truly covered and correctly coded services and they are Med Nec 3 Types of Reviews? - *Automated *Non Medical Record Review *Medical Record Review "Complex Review" An automated review includes? - Electronic info to detect improper payments. "technical denials" *Wrong info/ Incomplete info on the claim.