Coding Corner Question: June

Understanding Audits

In today’s healthcare climate, audits are on the rise. Don’t let the word “audit” put fear in your heart. Take the fear out of this process by knowing what to expect and learning more about auditors. Take this short quiz and find out how much you really know about Medicare audits.

Don’t despair if you miss a few questions. You may always contact our certified coder and auditor, Melesia Tillman, CPC-I, CRHC, CHA, at (404)-633-3777, ext. 820, or mtillman@rheumatology.org, for more information.

1. Which entities are allowed to audit Medicare claims?
   1. Medicare Administrative Contractor (MAC)
   2. Recovery Audit Contractor (RAC)
   3. Zone Program Integrity Contractor (ZPIC)
   4. Office of the Inspector General (OIG)
   5. All of the above
2. There is no limit on the number of claims a RAC can review or how often they can review claims.
   1. True
   2. False
3. What will happen if you refuse to comply with a surprise visit from a ZPIC?
   1. The visit will be rescheduled.
   2. They will leave and suspend the physician’s National Provider Identification (NPI) number.
   3. The contractor will shut the practice down and suspend the physician’s NPI number.
   4. None of the above. They will never go to a practice without notice.
4. A RAC can audit a claim previously audited by another entity.
   1. True
   2. False
5. How many levels of appeals are available to a provider?
   1. Five
   2. Four
   3. Three
   4. Two

click here for the answers.