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Domain 4 CDIP notes Part 1 of 6, Questions & Answers, 100% Accurate.
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Domain 4 CDIP notes Part 1 of 6, Questions & Answers, 100% Accurate. Why hire Medicare Contractor Reviewers? - -For Protection of Medicare Trust Fund. Who is 1st of 6 Medicare Contract Reviewers? - -(MACs) Medicare Administrative Contractors Whos is 2nd of 6 Medicare Contract Reviewers?...

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  • February 16, 2023
  • 6
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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  • domain 4 cdip notes part 1 of 6
  • questions amp answers
  • 100 accurate why hire medicare contractor reviewers for protection of medicare trust fund who is 1st of 6 medicare contract reviewe

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Domain 4 CDIP notes Part 1 of 6,
Questions & Answers, 100% Accurate.

Why hire Medicare Contractor Reviewers? - ✔✔-For Protection of Medicare Trust Fund.



Who is 1st of 6 Medicare Contract Reviewers? - ✔✔-(MACs) Medicare Administrative Contractors



Whos is 2nd of 6 Medicare Contract Reviewers? - ✔✔-(RACs) Recovery Auditor Contractors



Who's 3rd of 6 Medicare Contractor Reviewers? - ✔✔-(CERTs) Comprehensive Error Rate Testing
Contractors



Who's 4th of 6 Medicare Contract Reviewers? - ✔✔-(SMRCs) Supplemental Medical Review Contractors



Who's 5th of 6 Medicare Contract Reviewers? - ✔✔-(ZPICs) Zone Program Integrity Contractors



Who's 6th of 6 Medicare Contract Reviewers? - ✔✔-(UPICs) Unified Program Integrity Contractor



What are the MACs Responsible for? - ✔✔-Performed Medical Reviews of IPPS claims since 2008.



What's the purpose of a medical Review? - ✔✔-Validates Medicare payments are made on claims that
are truly covered and correctly coded services and they are Med Nec



3 Types of Reviews? - ✔✔-*Automated

*Non Medical Record Review

*Medical Record Review "Complex Review"

, An automated review includes? - ✔✔-Electronic info to detect improper payments. "technical denials"

*Wrong info/ Incomplete info on the claim.



What's the MCE? - ✔✔-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? - ✔✔-Compare submitted codes against unacceptable p Dx



NCCI - ✔✔-National Correct Coding Initiative.

* Non-complex review.

*ID's improper Coding that lead to Improper Payments, Accurate assignment of modifiers to prevent
denials



What 3 conventions are the coding policies based on? - ✔✔-*American Medical Association CPT manual,
*National And local Medicare policies and edits and *Coding guidelines developed by national societies,
standards and med



Non-medical Reviews? - ✔✔-*Manual intervention, determination based on only info included in claim,

*only performed on denials of related claims and

*when ADR is NOT submitted.



Complex Reviews? - ✔✔-Manual Review of health record! Medicare contract can review any info
necessary to make determination.



What will the contractor review to make the determination? - ✔✔-*Official coding guidelines.

*AHA coding clinic

*Medicare Program Manuals

*Other federal and local regulatory guidelines, this ensures claims are accurately coded.

*Billing hx and other info in file.

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