Certified Revenue Cycle Representative (CRCR) Practice Exam

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What is the primary function of Recovery Audit Contractors (RAC)?

To promote new healthcare standards
To analyze claims for potential overpayments
To manage patient grievances
To eliminate fraud in healthcare facilities

The correct answer is: To analyze claims for potential overpayments

The primary function of Recovery Audit Contractors (RAC) is to analyze claims for potential overpayments. RACs are utilized by the Centers for Medicare & Medicaid Services (CMS) to ensure that healthcare providers are billing accurately and in compliance with regulations. By conducting post-payment audits, RACs can identify instances where payments exceed what is deemed appropriate due to incorrect coding, billing errors, or other discrepancies. Their audits help ensure that healthcare providers receive proper payment and that funds are not misallocated, thus supporting the integrity of the Medicare program. While promoting new healthcare standards, managing patient grievances, and eliminating fraud in healthcare facilities are important aspects of the healthcare system, they are not the primary tasks of RACs. The focus remains on scrutinizing claim payments specifically to address and rectify overpayment issues, thereby helping to maintain the financial health of the healthcare system as a whole.