Domain 4 CDIP notes Part 1 of 6 (Intro to Denial Management) with Complete Solutions!

Why hire Medicare Contractor Reviewers? - ANSWER-For Protection of Medicare Trust Fund. Who is 1st of 6 Medicare Contract Reviewers? - ANSWER-(MACs) Medicare Administrative Contractors Whos is 2nd of 6 Medicare Contract Reviewers? - ANSWER-(RACs) Recovery Auditor Contractors Who's 3rd of 6 Medicare Contractor Reviewers? - ANSWER-(CERTs) Comprehensive Error Rate Testing Contractors Who's 4th of 6 Medicare Contract Reviewers? - ANSWER-(SMRCs) Supplemental Medical Review Contractors Who's 5th of 6 Medicare Contract Reviewers? - ANSWER-(ZPICs) Zone Program Integrity Contractors Who's 6th of 6 Medicare Contract Reviewers? - ANSWER-(UPICs) Unified Program Integrity Contractor What are the MACs Responsible for? - ANSWER-Performed Medical Reviews of IPPS claims since 2008. What's the purpose of a medical Review? - ANSWER-Validates Medicare payments are made on claims that are truly covered and correctly coded services and they are Med Nec 3 Types of Reviews? - ANSWER-*Automated *Non Medical Record Review *Medical Record Review "Complex Review" An automated review includes? - ANSWER-Electronic info to detect improper payments. "technical denials" *Wrong info/ Incomplete info on the claim. What's the MCE? - ANSWER-Medical Code Editor! It checks accuracy of code assignment prior to grouping. ID's where an unacceptable code is used as P Dx, also when it's a duplicate or the p Dx and secondary don't match w/ pt age or gender What do CMS data mining tools do? - ANSWER-Compare submitted codes against unacce