Payer Audit Defending Yourself Against the Inevitable

This webinar is AAPC-approved for 1.5 CEU Core A and/or CEDC, CPCO, CPMA specialty credits provided you score a 70% or higher on the post test. Test takers should read all test instructions, and complete the Required Information fields at the top of the test. This test consists of 15 questions. Please select one best answer for each test question by clicking on the square next to the answer you have selected. This test is not timed; however, the test must be taken in one sitting. When all 15 questions have been answered, please click on the Submit Test button. Your score, as well as logic-reach reasoning for answers to any test questions that you missed, will be displayed immediately following completion and successful transmission of this test.

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Name

Company Name

Email

RAC stands for:

Recovery Audit Contacts

Recovery Analysis Contractors

Recovery Audit Contractors

Random Audit Contractors

Payer audits tend to focus on:

Perceived aberrancy compared to other providers

Level Five followed by Critical Care

More common with Medicare MACs

All of the above

Fill in the blanks: Payer audits typically involve a review of between __ and __ charts:

100 and 150

20 and 40

30 and 60

10 and 15

What is the biggest area that governmental and non-governmental auditors focus on during audits?

Medical Necessity

Differential Diagnoses

Final Diagnosis

History and Exam

What is the best way for a provider to document Medical Necessity?

Long paragraphs that describe a provider’s thoughts regarding a patient’s work-up and therapy

Final Diagnosis

List of conditions provider is entertaining

Differential diagnoses list

Which of the following is indicative of a High Severity-type case:

Administration of one controlled substance (IV)

Patient is given meds, but no-work-up is performed

Case with two Special Studies (e.g., US and CT, CT and MRI or two CTs)

Case with one x-ray

Which of the following is indicative of a High Severity-type case:

1 nebulizer medication in 1 nebulizer treatment

Cases including a work-up and documentation of visualization of x-rays, Special Studies, and or EKGs

Case with one Special Study

1 IM controlled substance

A comprehensive chart audit summary should include:

Absolutely no demographic information

Examples from your code choice policies

Key elements of the patient encounter, and what was documented for each (HPI, Exam, PFSH, ROS, MDM)

Simply the chart itself

How many days do you have to file a 1^st level appeal response (Redetermination Response) following receipt of an overpayment notice from your Medicare carrier?

30 days

90 days

120 days

364 days

The most commonly seen Medicare audits focus on Level 3 cases.

True

False

There are five appeals levels in the Medicare appeals process.

True

False

Which of the following would indicate a high-severity case:

2 IV or IM meds

Four series of x-rays, or three and a Special Study

One Special Study

Two x-rays

How many days do you have to file a 2nd level appeal response (Reconsideration Response) following receipt of an unfavorable Redetermination Response Notice from a MAC?

180 days

60 days

120 days

90 days

How many days do you have to file a 3rd level appeal response following receipt of an unfavorable Reconsideration Response Notice from a QIC?

180 days

60 days

120 days

90 days

Which office handles all 3^rd level Medicare appeals:

Qualified Independent Contractor

Cahaba Government Benefit Administrators

Office of Medicare Hearings and Appeals

Q2 Administrators