IN CHARGE DUTIES
How much time in advance do you need to provide the draft exit report to your manager prior to scheduled exit conference call?
Two weeks, and manager should have it provided to partner by one week prior to exit conference call.
What does DRG mean?
Diagnosis related group
What folder houses email updates throughout the CMS busy season?
Email communications
You have 19 exceptions out of 20 samples in TrOOP testing
Finding
What is the national animal for Scotland?
Unicorn
What date do you need to include in your email to Jeff when notifying him you have dropped in your plan-provided populations in the I drive?
Fieldwork start date
What does the allowed amount represent?
The max allowed cost that CMS is permitting to be reimbursed to providers for different services.
Where can you find the MARx, HPMS, and Medispan logins?
CMS logins CY24 - Sign In Sheet
Observation
What is the name for the plastic or metal tube at the end of a shoelace?
Aglet
How many days after your exit conference is the final draft report due to CMS?
30 days
If a CPT code starts with an A, it is likely found in what fee schedule?
Ambulance
What is the report repository?
Where you can find prior year report findings and observations summarized by plans for aid in completing report wording.
DIR is overreported in your PD bid
Observation
What year was Mariah Carey’s “All I Want For Christmas Is You” released?
October 1994
What planning questionnaires should be sent out early in fieldwork phase?
How many claim lines are we testing for medical claims testing?
90! We are combining medical claims and unusual in one workpaper so the reporting tab is not referencing a separate workbook and all sample claim information is in one central location.
What folder are you uploading your plan-provided populations?
Files from Plans
You have 3 exceptions out of 5 samples in Plan to Plan Payment testing and each exception was paid 5 days late.
Observation or immaterial pass
What US president was a licensed bartender?
Abraham Lincoln
What file should you be frequently updating and communicating with your plan contact?
Summary of Audit Testing (SOAT)
When we have unallowable CPT codes processed by a plan, what are scenarios where these unallowed codes are actually allowed and legit claims?
- Claim was reversed within database, so no net effect to payment amount
- CPT code represents a service that the plan provides outline in the Explanation of Coverage packet, which is approved by CMS, so indirectly, the CPT code is approved by CMS and an exception to the un-allowability
What folder has the completed workpaper document for workpaper E-3?
You have 1 exception out of 10 samples in MOOP testing because the member overpaid and the plan said it was due to a system error.
Finding
What is ferret-legging?
Ferret-legging is a endurance sport in which competitors attempt to keep ferrets trapped in their pants for as long as possible.