CDIP Study Guide exam questions with
correct answers
The Department of Justice (DOJ) - Answer-Collaborates with many of the auditing
agencies include OIG and Dept of Health and Human Service. Can also perform audits.
Works on civil fraud cases and uses these same auditors to work on healthcare fraud
Comprehensive Error Rate Test (CERT) - Answer-Measures improper payments in the
Medicare Fee for Service program. Designed to comply with the Improper Medicare
FFS Payments Report
Health Care Fraud Prevention and Enforcement Action Team (Heat) - Answer-Prevents
fraud and abuse in Medicare and Medicaid programs by identifying fraud perpetrators
and those abusing the system
MAC'S - Medicare Administrative Contractors - Answer-Contracted to perform
prepayment medical reviews to ensure services provided to Medicare beneficiaries are
covered and medically necessary. All claims are put through a "scrubber" for check
edits. CMS publishes and maintains these edits. example- outpatient code edit (OCE)
How do MAC's calculate payments? - Answer-based on fee schedules, formulas,
geographical adjustments, provider characteristics, and beneficiary copayments
MIP- Medicaid integrity program - Answer-The first comprehensive federal strategy to
prevent fraud, waste, and abuse in the Medicaid program. CMS hires contractors to
review provider activities. Overseen by MIC's (Medicaid integrity Contractors)
What are the three types of Medicare Integrity Contractors - Answer-Review MIC's,
Audit MIC's, Education MIC's
Review MIC - Answer-This MIC analyzes Medicaid claims to determine potential fraud,
waste, or abuse
Audit MIC - Answer-This MIC audits provider claims and identifies overpayment
Education MIC - Answer-This MIC provides education to providers and others on
payment integrity and quality of care issues
Medicaid RAC - Answer-Supplemental approach to Medicaid program integrity efforts
already in place. Affordable care act of 2010 required establishment by Jan 1 2012
MFCU- Medicaid Fraud Control Unit - Answer-Entity of state government annually
certified by the secretary of HHS. Responsible for conducting a state initiative aimed at
correct answers
The Department of Justice (DOJ) - Answer-Collaborates with many of the auditing
agencies include OIG and Dept of Health and Human Service. Can also perform audits.
Works on civil fraud cases and uses these same auditors to work on healthcare fraud
Comprehensive Error Rate Test (CERT) - Answer-Measures improper payments in the
Medicare Fee for Service program. Designed to comply with the Improper Medicare
FFS Payments Report
Health Care Fraud Prevention and Enforcement Action Team (Heat) - Answer-Prevents
fraud and abuse in Medicare and Medicaid programs by identifying fraud perpetrators
and those abusing the system
MAC'S - Medicare Administrative Contractors - Answer-Contracted to perform
prepayment medical reviews to ensure services provided to Medicare beneficiaries are
covered and medically necessary. All claims are put through a "scrubber" for check
edits. CMS publishes and maintains these edits. example- outpatient code edit (OCE)
How do MAC's calculate payments? - Answer-based on fee schedules, formulas,
geographical adjustments, provider characteristics, and beneficiary copayments
MIP- Medicaid integrity program - Answer-The first comprehensive federal strategy to
prevent fraud, waste, and abuse in the Medicaid program. CMS hires contractors to
review provider activities. Overseen by MIC's (Medicaid integrity Contractors)
What are the three types of Medicare Integrity Contractors - Answer-Review MIC's,
Audit MIC's, Education MIC's
Review MIC - Answer-This MIC analyzes Medicaid claims to determine potential fraud,
waste, or abuse
Audit MIC - Answer-This MIC audits provider claims and identifies overpayment
Education MIC - Answer-This MIC provides education to providers and others on
payment integrity and quality of care issues
Medicaid RAC - Answer-Supplemental approach to Medicaid program integrity efforts
already in place. Affordable care act of 2010 required establishment by Jan 1 2012
MFCU- Medicaid Fraud Control Unit - Answer-Entity of state government annually
certified by the secretary of HHS. Responsible for conducting a state initiative aimed at
