Level 3 Competency Validation

MASTER Compliance Specialist Assessment - 90% Required to Pass

10 Expert Scenarios Testing Audit Defense, Compliance & Regulatory Mastery

Question 1 of 1010% Complete

MAC Audit Defense

MAC Audit Challenge - Complex Tier Defense

Patient Information:

Name: Eleanor Martinez

Age: 78

Admission Diagnosis: Left femur fracture s/p ORIF

Medical History:

Type 2 Diabetes with peripheral neuropathy
Chronic Kidney Disease Stage 3b (eGFR 36)
Atrial fibrillation on anticoagulation (stable)
Osteoarthritis bilateral knees
History of colon cancer (resected 8 years ago, NED)

Current Medications:

Insulin glargine 20 units daily
Metformin 1000mg BID
Apixaban 5mg BID
Acetaminophen PRN
Gabapentin 300mg TID for neuropathy

Functional Status: Admission FIM: Motor 26, Cognitive 28. Requires moderate assist for mobility and ADLs.

🚨 Audit Context:

MAC auditor challenges Tier 2 assignment, stating that atrial fibrillation on stable anticoagulation doesn't require 'active treatment' and osteoarthritis is not a qualifying comorbidity.

What is your STRONGEST defense for maintaining Tier 2 assignment?

Argue that all documented comorbidities should count regardless of active treatment

Present evidence: Daily glucose monitoring logs, insulin dose adjustments (3 changes in 2 weeks), nephrology consultation for CKD management, and neuropathy pain management protocol

Concede Tier 2 is incorrect and accept downgrade to Tier 1

Argue that the auditor's interpretation of 'active treatment' is too strict

Answered: 0 of 10

Level 3 MASTER Assessment Requirements:

90% or higher score required to achieve MASTER level
10 expert scenarios covering MAC audit defense, regulatory compliance, appeals, and expert coding
Passing validates expertise in audit defense and compliance mastery
Combined with Level 3 module completion, qualifies for GOLD MASTER certification