Question

Which of the following types of corrective actions can be imposed by a MAC as a result of a complex medical review?

I. Provider notification / feedback II. Prepayment or Postpayment review III. Criminal litigation
a. I only
b. I and II only
C. I, II, and III
d. III only

Answer 1

Corrective actions following a complex medical review by a MAC typically include provider notification/feedback and prepayment or postpayment review. Criminal litigation is not directly imposed by a MAC but could result from a referral.

Step-by-step explanation:

As a result of a complex medical review by a Medicare Administrative Contractor (MAC), several types of corrective actions can be imposed. These actions may include:

• Provider notification / feedback - to inform healthcare providers about the findings of the review and guide them towards compliant billing practices.
• Prepayment or Postpayment review - where claims are scrutinized either before payment is made to ensure they comply with Medicare rules or after payment to verify the same.
• Criminal litigation - although this action is not commonly pursued directly by a MAC following a complex medical review, findings from the review could potentially be referred to law enforcement if fraud or misuse is suspected.

Therefore, the correct answer to the question about types of corrective actions imposed by a MAC as a result of a complex medical review would be b. I and II only.