AHFI Exam Questions & 100% Verified Answers solutions
UPDATE 2026 STUDY GUIDE EXAM
Guidelines Regarding which documents Review Contractors will consider -
VERIFIED ANSWER - The review contractor shall consider all medical
record entries made by physicians and LCMPs (Licensed/certified
medical professional) - medical professional licensed or certified to
practice in the state in which services are rendered.)
The physician / LCMP should be aware that inadequate medical record
documentation - VERIFIED ANSWER - Can lead to a financial liability for the
beneficiary and/or supplier, should the reviewer determine that a claim
is not supported.
Scribes - VERIFIED ANSWER - Scribes are not providers of items or
services. When a scribe is used by a provider in documenting medical
record entries (E. G., Progress notes), CMS does not require the scribe to
sign/date the documentation. The treating physician's/non-physician's
(NPPs) signature on a note indicates that the physician/NPP affirms the
note adequately documents the care provided.
,Reviews are instructed to look for the signature & date of the treating
physician/NPP on the note. They shall not deny claims for items or
services because the scribe did not sign/date the note.
COP - VERIFIED ANSWER - Conditions of participation (Cop) are not
conditions of payment.
Reasons for denial - VERIFIED ANSWER - If Mac and Cert Reviewers find
reasons for denial unrelated to signature requirements, the reviewer
need not proceed to signature authentication.
If criteria in the relevant Medicare policy cannot be met but for a key
piece of medical documentation that contains a missing or illegible
signature, the reviewer shall proceed to the signature assessment.
Late signatures - VERIFIED ANSWER - Providers should not add late
signatures to the medical record.
Types of reviews: MACs - VERIFIED ANSWER - Do ALL "5" types of reviews
Prepayment Medical Reviews
,Non-medical Record Reviews
Automated Reviews
Postpayment Medical Record
Reviews
Postpayment Non-medical
Record Reviews
Types of reviews: CERT - VERIFIED ANSWER - Only Postpayment Medical
Record Reviews
Types of reviews: RACs - VERIFIED ANSWER - Do only Postpayment Medical
Record Reviews
Types of reviews: SMRC - VERIFIED ANSWER - Do only Postpayment Medical
Record Reviews; and,
Postpayment Non-medical Record Reviews
Types of reviews: ZIP/UPIC - VERIFIED ANSWER - Do
, Prepayment Medical Record Reviews
Postpayment Medical Record Reviews
Postpayment Non-medical Record Reviews
Amendments, corrections and Delayed Entries in Medical Documentation -
VERIFIED ANSWER - All services provided to beneficiaries are expected to
be documented in the medical record at the time they are rendered
The MACs, Cert, Recovery Auditors, and ZPICs shall NOT consider any
entries that do no comply with the principles listed in section B, even if
such exclusion would lead to a claim denial. (Example: They shall not
consider undated or unsigned entries handwritten in the margin of a
document. They shall exclude these entries from consideration.)
Record keeping Principles - VERIFIED ANSWER - Documents submitted ot
MACs, Cert, Recovery Auditors, and ZPICs containing amendments,
corrections, or addenda must:
UPDATE 2026 STUDY GUIDE EXAM
Guidelines Regarding which documents Review Contractors will consider -
VERIFIED ANSWER - The review contractor shall consider all medical
record entries made by physicians and LCMPs (Licensed/certified
medical professional) - medical professional licensed or certified to
practice in the state in which services are rendered.)
The physician / LCMP should be aware that inadequate medical record
documentation - VERIFIED ANSWER - Can lead to a financial liability for the
beneficiary and/or supplier, should the reviewer determine that a claim
is not supported.
Scribes - VERIFIED ANSWER - Scribes are not providers of items or
services. When a scribe is used by a provider in documenting medical
record entries (E. G., Progress notes), CMS does not require the scribe to
sign/date the documentation. The treating physician's/non-physician's
(NPPs) signature on a note indicates that the physician/NPP affirms the
note adequately documents the care provided.
,Reviews are instructed to look for the signature & date of the treating
physician/NPP on the note. They shall not deny claims for items or
services because the scribe did not sign/date the note.
COP - VERIFIED ANSWER - Conditions of participation (Cop) are not
conditions of payment.
Reasons for denial - VERIFIED ANSWER - If Mac and Cert Reviewers find
reasons for denial unrelated to signature requirements, the reviewer
need not proceed to signature authentication.
If criteria in the relevant Medicare policy cannot be met but for a key
piece of medical documentation that contains a missing or illegible
signature, the reviewer shall proceed to the signature assessment.
Late signatures - VERIFIED ANSWER - Providers should not add late
signatures to the medical record.
Types of reviews: MACs - VERIFIED ANSWER - Do ALL "5" types of reviews
Prepayment Medical Reviews
,Non-medical Record Reviews
Automated Reviews
Postpayment Medical Record
Reviews
Postpayment Non-medical
Record Reviews
Types of reviews: CERT - VERIFIED ANSWER - Only Postpayment Medical
Record Reviews
Types of reviews: RACs - VERIFIED ANSWER - Do only Postpayment Medical
Record Reviews
Types of reviews: SMRC - VERIFIED ANSWER - Do only Postpayment Medical
Record Reviews; and,
Postpayment Non-medical Record Reviews
Types of reviews: ZIP/UPIC - VERIFIED ANSWER - Do
, Prepayment Medical Record Reviews
Postpayment Medical Record Reviews
Postpayment Non-medical Record Reviews
Amendments, corrections and Delayed Entries in Medical Documentation -
VERIFIED ANSWER - All services provided to beneficiaries are expected to
be documented in the medical record at the time they are rendered
The MACs, Cert, Recovery Auditors, and ZPICs shall NOT consider any
entries that do no comply with the principles listed in section B, even if
such exclusion would lead to a claim denial. (Example: They shall not
consider undated or unsigned entries handwritten in the margin of a
document. They shall exclude these entries from consideration.)
Record keeping Principles - VERIFIED ANSWER - Documents submitted ot
MACs, Cert, Recovery Auditors, and ZPICs containing amendments,
corrections, or addenda must:
