Certified Inpatient Coding (CIC) Practice Exam

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Which organizations are required to notify providers of their intent to review services by posting issues online?

  1. ZPICs

  2. MACs

  3. CERTs

  4. RACs

The correct answer is: RACs

The Recovery Audit Contractors (RACs) are required to notify providers of their intent to review services by posting issues online. This is part of their role in identifying and correcting improper payments in the Medicare program. By publishing their findings and the issues they intend to review, RACs aim to increase transparency and help providers understand potential areas of concern that may lead to audits. This process enables providers to engage proactively with the auditing process, ensuring that they can address any issues before the audits take place. Other organizations listed serve different functions in the healthcare landscape. Zone Program Integrity Contractors (ZPICs) focus on detecting and preventing fraud, waste, and abuse in Medicare, but they do not have the same online notification requirement regarding audits. Medicare Administrative Contractors (MACs) process Medicare claims and provide education to providers, but they also do not have this specific obligation. Comprehensive Error Rate Testing contractors (CERTs) aim to measure improper payments but do not share audit intentions publicly in the same manner.