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Revascent RCM Webinar Series

CMS Audits Uncovered: A Guide to Audit Types and Key Considerations

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1) The CMS Improper Payment Data Report is based on audit findings from what type of CMS Audit? (Select one)

TPE (Target, Probe and Education UPIC (Unified Program Integrity Contractors CERT (Comprehensive Error Rate Testing) RAC (Recovery Audit Contractor)

2) The overpayment lookback period for CMS is: (Select one)

There is no lookback period 1 year 6 years 3 years

3) (Complete this sentence) When providers/organizations enter into a Corporate Integrity Agreement with the OIG, they agree to meet the obligations, and in exchange, the OIG agrees not to seek their _________ from participation in Medicare, Medicaid, or other Federal health care programs.

4) The following elements are included in a Corporate Integrity Agreement: (Select one)

Hire a compliance officer/appoint a compliance committee Develop written standards and policies Retain an independent review organization to conduct annual reviews None of the above All of the above

5) The typical sample size for a Target, Probe and Educate audit is: (Select one)

Random number of claims, there is no standard 10-20 50 20-40

6) (Complete this sentence) The top root cause for improper payments related to lab services in the 2024 Improper Payment report is _________________________________.

7) Emergency Room Visits have an overall improper payment rate of what percentage in the 2024 CMS Improper Payment Data report: (Select one)

7.5% 11% 12.5% 25%

8) The primary purpose of a UPIC audit is to: (Select one)

Train and educate providers Identify high claim denial rates Identify potentially fraudulent billing that could indicate fraud, waste and abuse. None of the above

9) When should a provider consider using the CMS Self-Disclosure Protocol? (Select one)

After an OIG audit uncovers overpayments When the provider identifies potential violations of Stark Law or Anti-Kickback Statute When appealing a RAC audit decision Only when requested by CMS

10) The main focus of RAC (Recovery Audit Contractor) audits is to:

Educate providers on correct billing practices Identify and recover improper Medicare and Medicaid payments Investigate fraud and refer cases for criminal prosecution Review claims for prior authorization compliance

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Revascent RCM Webinar Series

CMS Audits Uncovered: A Guide to Audit Types and Key Considerations

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Speak to our team today

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