CPCO CHAPTER 11 REVIEW 2025
QUESTIONS AND ANSWERS
Can providers request an extension for providing records requested by an auditor
if there is a problem meeting the deadline? - ....ANSWER ...-Yes, by calling
the requestor and explaining the reason for delay
Response Feedback:
Rationale: If there is a problem meeting the deadline, call the requestor to explain
the reason for the delay and ask for an extension.
What established the Medicaid Integrity Program? - ....ANSWER ...-Section
1936 of the Social Security Act
Response Feedback:
Section 1936 of the Social Security Act created the Medicaid Integrity Program
(MIP) and directed the CMS to enter into contracts to review Medicaid provider
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, actions, audit claims, identify overpayments, and educate providers and others on
Medicaid program integrity issues.
The Compliance Officer asked the Billing Manager at Orange Hospital how many
days they had to send CERT contractor documentation. The Billing Manager said
that documentation had to be sent to the CERT contractor within: -
....ANSWER ...-75 days
Response Feedback:
75 days. The CERT documentation contractor may request medical records from
the provider or supplier who submitted the claim:
For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services),
additional documentation requests are also made to the referring provider who
ordered the item or service.
If no documentation is received within 75 days of the initial request, the claim is
classified as a "no documentation" claim and counted as an error.
If documentation is received after 75 days of the initial request (late
documentation), CERT will still review the claim.
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)? -
....ANSWER ...-Limited to investigating Medicaid provider fraud
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
QUESTIONS AND ANSWERS
Can providers request an extension for providing records requested by an auditor
if there is a problem meeting the deadline? - ....ANSWER ...-Yes, by calling
the requestor and explaining the reason for delay
Response Feedback:
Rationale: If there is a problem meeting the deadline, call the requestor to explain
the reason for the delay and ask for an extension.
What established the Medicaid Integrity Program? - ....ANSWER ...-Section
1936 of the Social Security Act
Response Feedback:
Section 1936 of the Social Security Act created the Medicaid Integrity Program
(MIP) and directed the CMS to enter into contracts to review Medicaid provider
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, actions, audit claims, identify overpayments, and educate providers and others on
Medicaid program integrity issues.
The Compliance Officer asked the Billing Manager at Orange Hospital how many
days they had to send CERT contractor documentation. The Billing Manager said
that documentation had to be sent to the CERT contractor within: -
....ANSWER ...-75 days
Response Feedback:
75 days. The CERT documentation contractor may request medical records from
the provider or supplier who submitted the claim:
For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services),
additional documentation requests are also made to the referring provider who
ordered the item or service.
If no documentation is received within 75 days of the initial request, the claim is
classified as a "no documentation" claim and counted as an error.
If documentation is received after 75 days of the initial request (late
documentation), CERT will still review the claim.
What is the jurisdiction limit of Medicaid Fraud Control Units (MFCUs)? -
....ANSWER ...-Limited to investigating Medicaid provider fraud
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
