Question

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Explanation:

Identify the entities performing Medical Review (MR)

Under the Centers for Medicare & Medicaid Services (CMS) guidelines, several contractors are authorized to conduct claims Medical Review (MR) to prevent, detect, and report fraud, waste, and abuse. These entities include Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing (CERT) contractors, and Recovery Audit Program Recovery Auditors (RACs).

Evaluate the options

• Option A: Medicare Administrative Contractors (MACs) perform medical reviews on claims before and after payment.
• Option B: Comprehensive Error Rate Testing (CERT) Contractors perform medical reviews on a random sample of claims to calculate the improper payment rate.
• Option C: Recovery Audit Program Recovery Auditors identify and correct underpayments and overpayments through medical review.
• Option D: Since all three entities (MACs, CERT, and Recovery Auditors) conduct claims Medical Review, "All of the above" is the correct choice.

Answer:

• (A) A. Medicare Administrative Contractors (MACs)
• (B) B. Comprehensive Error Rate Testing (CERT) Contractors
• (C) C. Recovery Audit Program Recovery Auditors
• (D) D. All of the above (Correct answer)