Chapter 1 CPMA Exam
Prep 2026 | Questions,
Answers & Detailed
Rationales Study Guide
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Updated 2026 Questions and Answers
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Rationales
Included
, 5 Common reasons for overpayment are: *Billing for excessive and subsequent payment of the same service or claim.
*Duplicate submission and payment for same service or claim
*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or condition
*Payment to an incorrect payee.
MACs Medicare Administrative Contractors
MAC Responsibilities Process claims from physicians, hospitals, and other health care professionals, and
submit payment to those providers according to Medicare rules and regulations
(including identifying under- and overpayments).
ZPICs Zone Program Integrity Contractors
PSCs Program Safeguard Contractor
ZPICs/PSCs Perform investigations that are unique and tailored to specific circumstances and
occur only in situations where there is potential fraud, and take appropriate
corrective actions
SMRC Supplemental Medical Review Contractor
SMRC Responsibilities Conduct nationwide medical review as directed by CMS (includes identifying
underpayments and overpayments
Medicare FFS Recovery Auditors Review claims to identify potential underpayments and overpayments in Medicare
FFS, as part of the Recovery Audit Program
Zone 6 All PSCs transitioned to ZPICs with the exception of Zone 6
While all contractors focus on a specific area, Each contractor conducting a claim review must apply all Medicare policies to the
claim under review. Additionally, once a claim is reviewed, a different contractor
should not reopen it. Therefore, it is important when conducting claim reviews,
contractors review each claim in its entirety.
Claim Review Programs There are 5 claim review programs
NCCI Edits National Correct Coding Initiative Editor
Prep 2026 | Questions,
Answers & Detailed
Rationales Study Guide
|Graded A+ | Guaranteed
success|
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales
Included
, 5 Common reasons for overpayment are: *Billing for excessive and subsequent payment of the same service or claim.
*Duplicate submission and payment for same service or claim
*Payment for excluded or Medically unnecessary services.
*Payment for services in setting not appropriate to pt's needs or condition
*Payment to an incorrect payee.
MACs Medicare Administrative Contractors
MAC Responsibilities Process claims from physicians, hospitals, and other health care professionals, and
submit payment to those providers according to Medicare rules and regulations
(including identifying under- and overpayments).
ZPICs Zone Program Integrity Contractors
PSCs Program Safeguard Contractor
ZPICs/PSCs Perform investigations that are unique and tailored to specific circumstances and
occur only in situations where there is potential fraud, and take appropriate
corrective actions
SMRC Supplemental Medical Review Contractor
SMRC Responsibilities Conduct nationwide medical review as directed by CMS (includes identifying
underpayments and overpayments
Medicare FFS Recovery Auditors Review claims to identify potential underpayments and overpayments in Medicare
FFS, as part of the Recovery Audit Program
Zone 6 All PSCs transitioned to ZPICs with the exception of Zone 6
While all contractors focus on a specific area, Each contractor conducting a claim review must apply all Medicare policies to the
claim under review. Additionally, once a claim is reviewed, a different contractor
should not reopen it. Therefore, it is important when conducting claim reviews,
contractors review each claim in its entirety.
Claim Review Programs There are 5 claim review programs
NCCI Edits National Correct Coding Initiative Editor
