ABQUARP EXAM 2026 EXAM
REVIEW PRACTICE MOCK PACK
PRACTICE QUESTION DRILLS
◉ Data Sources Available for Profiling. Answer:
Administrative Date- billing, membership mgt, pharm benefits-
widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction
(need non-responders)
◉ MIP-Medicare Integrity Program. Answer: established in the
HIPAA*health insurance portability and accountability act)
1996 to address fraud
The DRA (deficit reduction act) 2006 signed into law 2006 and
created MIP. They contract c private entities to provide audits,
medical necc, ID fraud
◉ CPI=center for program integrity. Answer: 2010-integrate
prevention, detection, recovery and transparency and
accountability
◉ FPS-Fraud Prevention System. Answer: 2011-analyzes
Medicare fee for service claims using risk based algorithms
◉ One Program Integrity-One PI. Answer: provides integrated
searchable database to Medicare claims across the IDR
(Integrated Data Base) Helps detect fraud, waste and abuse.
◉ CNC-Compromised Number Checklist. Answer: 2011-
Updated monthly of Medicare beneficiary and provider ID #
looking if any have been compromised
-appx 5000 providers and 280K beneficiaries were
compromised.
, ◉ Medicare payments. Answer: Must pay 95% within 30d, pay
or deny all claims within 60d
Only 1% are audited
◉ MAC-Medicare Administrative Contractors. Answer: With
MMA( Medicare prescription drug improvement and
modernization act) Medicare will contract claims payment.
-Also do audits, education for billing, eval bene c/o
◉ PSC and ZPICs
Program Safeguard contractors and Zone Program Integrity
Contractors. Answer: national and regional data analysis to look
for fraud and refer to prosecution. Focus on Medicare A/B 18
PSC and 5 hot spot Zones and 2 other zones for 24 states.
◉ RAC- Recovery Audit Contractors. Answer: correct past
improper payments and implement actions to prevent future
improper payments. for Medicare
◉ MEDICS=Medicare Part D Integrity Contractors. Answer: 2
look for fraud, waste and abuse for part D
-results of the MMA ( Medicare Modernization Act)
◉ CMSA- Case Mgt Society of America. Answer: 1995- put
forth first standards of practice for CM.
-communication, coordination and collaboration of health care
◉ Patient Protection and Affordable Care Act. Answer: 2010-
sited CM is important to ensure high quality , safe pt care
◉ 5 basic principals of ethical practice for CM. Answer: J-
justice ( treat all fairly)
A-autonomy-respect pt right to make own decision
N-non-malfeasance-do no harm
F-fidelity-keep your promise
B-beneficence-to do good
REVIEW PRACTICE MOCK PACK
PRACTICE QUESTION DRILLS
◉ Data Sources Available for Profiling. Answer:
Administrative Date- billing, membership mgt, pharm benefits-
widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction
(need non-responders)
◉ MIP-Medicare Integrity Program. Answer: established in the
HIPAA*health insurance portability and accountability act)
1996 to address fraud
The DRA (deficit reduction act) 2006 signed into law 2006 and
created MIP. They contract c private entities to provide audits,
medical necc, ID fraud
◉ CPI=center for program integrity. Answer: 2010-integrate
prevention, detection, recovery and transparency and
accountability
◉ FPS-Fraud Prevention System. Answer: 2011-analyzes
Medicare fee for service claims using risk based algorithms
◉ One Program Integrity-One PI. Answer: provides integrated
searchable database to Medicare claims across the IDR
(Integrated Data Base) Helps detect fraud, waste and abuse.
◉ CNC-Compromised Number Checklist. Answer: 2011-
Updated monthly of Medicare beneficiary and provider ID #
looking if any have been compromised
-appx 5000 providers and 280K beneficiaries were
compromised.
, ◉ Medicare payments. Answer: Must pay 95% within 30d, pay
or deny all claims within 60d
Only 1% are audited
◉ MAC-Medicare Administrative Contractors. Answer: With
MMA( Medicare prescription drug improvement and
modernization act) Medicare will contract claims payment.
-Also do audits, education for billing, eval bene c/o
◉ PSC and ZPICs
Program Safeguard contractors and Zone Program Integrity
Contractors. Answer: national and regional data analysis to look
for fraud and refer to prosecution. Focus on Medicare A/B 18
PSC and 5 hot spot Zones and 2 other zones for 24 states.
◉ RAC- Recovery Audit Contractors. Answer: correct past
improper payments and implement actions to prevent future
improper payments. for Medicare
◉ MEDICS=Medicare Part D Integrity Contractors. Answer: 2
look for fraud, waste and abuse for part D
-results of the MMA ( Medicare Modernization Act)
◉ CMSA- Case Mgt Society of America. Answer: 1995- put
forth first standards of practice for CM.
-communication, coordination and collaboration of health care
◉ Patient Protection and Affordable Care Act. Answer: 2010-
sited CM is important to ensure high quality , safe pt care
◉ 5 basic principals of ethical practice for CM. Answer: J-
justice ( treat all fairly)
A-autonomy-respect pt right to make own decision
N-non-malfeasance-do no harm
F-fidelity-keep your promise
B-beneficence-to do good
