Which organization identifies improper payments made on CMS claims?

Prepare for the NHA Certified Billing and Coding Specialist (CBCS) Exam with engaging quizzes. Study with multiple choice questions, each offering hints and explanations, to enhance your understanding and readiness for the exam!

Multiple Choice

Which organization identifies improper payments made on CMS claims?

Explanation:
The Recovery Audit Contractor program is CMS’s method for finding improper payments in claims. These contractors perform post-payment reviews of Medicare fee-for-service (and related CMS programs) to spot errors such as incorrect coding, duplicate or unallowable claims, and services not medically necessary. When improper payments are identified, CMS recovers the overpaid funds and uses the findings to strengthen billing rules and provider education, reducing future errors. The other names listed aren’t official CMS programs, so they don’t identify improper CMS claim payments.

The Recovery Audit Contractor program is CMS’s method for finding improper payments in claims. These contractors perform post-payment reviews of Medicare fee-for-service (and related CMS programs) to spot errors such as incorrect coding, duplicate or unallowable claims, and services not medically necessary. When improper payments are identified, CMS recovers the overpaid funds and uses the findings to strengthen billing rules and provider education, reducing future errors. The other names listed aren’t official CMS programs, so they don’t identify improper CMS claim payments.

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