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Understanding The Medicare Appeals Process And The Medicare Manual For Rehabilitation Services

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1.  RAC stands for Recent Action Committee Review Activity Consultation Recovery Audit Contractors Reviewed Action Content

2.  Florida is in what RAC region? Region 3 Region 4 Region 2 Region 1

3.  Per the Medicare Benefit Policy Manual, a Clinician refers to all of the following except: Occupational Therapy Assistant Speech Language Pathologist Physical Therapist Occupational Therapist

4.  The Centers for Medicare & Medicaid Services complete these to identify improperly paid medical claims: Administrative Law Judge Hearings Recovery Audits using Recovery Audit Contractors (RAC) Independent Claim Reviews Additional Record Requests

5.  Per the Medicare Benefit Policy Manual, treatment can begin: Once the plan of care is established Once the therapist meets the patient Once the chart review is complete Once the evaluation is initiated

6.  Recovery Audit Contractors review claims on post-payment basis in order to: Predict future areas of audit Process Medicare A claims Educate on a QIC Detect and correct past improper payments

7.  Per section 220.3, the minimal expectations include all of the following except: Pictures of the training Evaluation and POC Certification Treatment notes

8.  In order to file an appeal with an Administrative Law Judge, the case needs to involve at least this amount in dispute? $5000 $160 $1560 $500

9.  According to the Manual, Long Term Goals on evaluation should: Be brief Be a general overview Include all areas of short term goals Be measurable and pertain to function

10.  In order to be considered reasonable and necessary, services must include all of the following except: Certified plan of care, signed by a physician Services are provided by a supervised unqualified staff when a therapist is not available Services require the sophisticated skills of a therapist or assistant Services are designed to improve or maintain the patient's current condition