EXPIRATION DATE: SEPTEMBER 1, 2011
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Journal of AHIMA
Continuing Education Quiz
Quiz ID: Q113823 | HIM Domain Area: Clinical Data Management | Article—“RAC Forensics 101: Part 3”
REFER TO THE ARTICLE for the one best answer to each question. Questions are based solely on the
content of the article.
1. Level II of the appeals process is:
;a. reconsideration
;b. redetermination
;c. discussion
;d. Medicare Appeals Council
For an opportunity to receive CE credit
of 1 clock hour, mail this form with the
appropriate processing fee to:
2. At level III CMS will recoup the
overpayment plus interest.
;a. true
;b. false
AHIMA
Journal of AHIMA CE Quiz
PO Box 77-2735
Chicago, IL 60678-2735
Forms must be received by the
“Expiration Date” above.
3. To present a case to the administrative
law judge, the amount in controversy
must be at least:
;a. $80,000
;b. $100,000
;c. $130,000
;d. none of the above
6. In appealing a coding denial, all of
the following steps are recommend
except:
;a. reviewing the chargemaster
information submitted on the bill
;b. reviewing the content of the
documentation related to the
denial
;c. reviewing regulatory guidance
with regard to the date of the
account
;d. determining if additional
documentation is needed
7. The last level at which additional
documentation can be provided is
level:
;a. I
;b. II
;c. III
;d. IV
First Name (please print)
4. What level of appeal allows up to 120
days to file a request, but the request
must be filed within 30 days to avoid
recoupment?
;a. discussion
;b. redetermination
;c. reconsideration
;d. administrative law judge
Last Name
8. When submitting an appeal,
organizations should consider all of
the following except:
;a. conferring with the attending
physician
;b. adding appropriate
interdisciplinary team notes
;c. providing documentation from
previous admissions
;d. including references to
medications and ancillary tests
AHIMA Membership ID Number
Address
5. Automated denials:
;a. offer increased opportunity for
appeal
;b. may require legal expertise
;c. are oftentimes related to a rule
change
;d. may require physician involvement
9. It is recommended that the appeals
process always be managed by an
external contractor.
;a. true
;b. false
City
State, Zip Code
10. The RAC should forward the record to
the FI for the first level of appeal.
;a. true
;b. false
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* $25, Non-member
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