CIC Exam Prep - Chapter 12 Questions
And Answers
The federal ___________ law prohibits anyone (a person or corporate entity) from intentionally soliciting
or receiving remuneration (anything of value such as bribes, rebates, Cash, etc.), directly or indirectly, to
get Patient referrals and/or additional business reimbursed under federal healthcare Programs Such as
Medicare and Medicaid. - Answer - anti-kickback
The purpose of the anti-kickback rule is to protect patients and federal healthcare programs from
_________ and _______ . - Answer - fraud and abuse
The ___________ Law governs physician self-referral for Medicare and Medicaid patients. Also known
as the "physician self-Referral law,'' this statute prohibits physicians from referring patients to medical
facilities in which the physician or a member of the Physician's immediate family has a financial interest,
Whether by ownership, investment, or a Compensation arrangement. It includes services billed by
hospitals but provided by a Physician-Owned entity under contract with the hospital. - Answer - Stark
The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of
2003 (MMA) to identify and _________ improper Medicare payments paid to healthcare providers
under fee-for-Service (FFS) Medicare Plans. The RAC program began as a Medicare demonstration
Program. - Answer - recover
RACs employ two types of audit processes: __________ and ________. - Answer - automated and
complex
An _________ audit focuses on easily detectable payment errors. Given the ease of detectability, the
automated process requires no human review or medical records to determine a finding of improper
payment. - Answer - automated
The ___________ audit targets improper payments that cannot be determined based on a simple
review, requiring manual evaluation of medical records and supporting documentation to determine a
finding. - Answer - complex
Currently, the RACs are held to a _____ -year look back period for the identification of improper
payments. - Answer - 3
And Answers
The federal ___________ law prohibits anyone (a person or corporate entity) from intentionally soliciting
or receiving remuneration (anything of value such as bribes, rebates, Cash, etc.), directly or indirectly, to
get Patient referrals and/or additional business reimbursed under federal healthcare Programs Such as
Medicare and Medicaid. - Answer - anti-kickback
The purpose of the anti-kickback rule is to protect patients and federal healthcare programs from
_________ and _______ . - Answer - fraud and abuse
The ___________ Law governs physician self-referral for Medicare and Medicaid patients. Also known
as the "physician self-Referral law,'' this statute prohibits physicians from referring patients to medical
facilities in which the physician or a member of the Physician's immediate family has a financial interest,
Whether by ownership, investment, or a Compensation arrangement. It includes services billed by
hospitals but provided by a Physician-Owned entity under contract with the hospital. - Answer - Stark
The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of
2003 (MMA) to identify and _________ improper Medicare payments paid to healthcare providers
under fee-for-Service (FFS) Medicare Plans. The RAC program began as a Medicare demonstration
Program. - Answer - recover
RACs employ two types of audit processes: __________ and ________. - Answer - automated and
complex
An _________ audit focuses on easily detectable payment errors. Given the ease of detectability, the
automated process requires no human review or medical records to determine a finding of improper
payment. - Answer - automated
The ___________ audit targets improper payments that cannot be determined based on a simple
review, requiring manual evaluation of medical records and supporting documentation to determine a
finding. - Answer - complex
Currently, the RACs are held to a _____ -year look back period for the identification of improper
payments. - Answer - 3
