Medicare beneficiaries - Study guides, Class notes & Summaries

AHIP - Final Examination (Latest Update 2022) Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? - Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his ...

AHIP 2021 Bundle 55 pages overall. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? a. Medicare Part B generally provides prescription drug coverage. b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. c. Medicare Part A generally...

2024 AHIP Medicare Training ( Brand New !!!) Actual Questions and Answers 100% Correct 1. Mr.Wu is eligible for Medicare. He has limited financial resources but failedto qualify for the Part D low-income subsidy.Where might he turn for help withhis prescription drug costs? Answer: -Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. 2. What impact, if any, will recent regulatory changes have upon Medigapplans? Answer: -The Part...

HCCA CHC Exam Prep | 750+ Questions and Verified Answers| 2023/ 2024 Q: True of False: A self-audit is an examination or inspection for providers in reducing non-compliance. Self-audits can lower chances of an external audit and create a robust culture of compliance Answer: True Source: CHC Exam Secrets Study Guide Q: CMS released areas of high-risk fraud, some of those include: A. Sudden changes in billing and billing inappropriate specialties B. Billing of inappropriate d...

CRCR EXAM WITH CORRECT CHOICES, CERTIFIED AND VERRIFIED What are collection agency fees based on? - CORRECT ANSWER-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWER-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWER-Case rates What customer service improvements might improve the patie...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

Texas Life And Health Insurance Exam Questions With Correct Answers | Latest 2023/2024 (Graded A+). Which of the following actions is NOT possible with a Universal Life policy? - Correct Answer-Premiums may be applied as a credit against income tax Which of the following will a Long Term Care plan typically provide benefits for? - Correct Answer-home health care Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that...

HFMA: Healthcare Financial Management Association Exam (2024 / 2025) Questions and Verified Answers 1. Which of the following options is an alternative to valid long-term payment plans? ~ Answer: Bank loans 2. What type of plan restricts benefits for nonemergency care to approved providers only? ~ Answer: A PPO (preferred provider organization) plan 3. What does scheduling allow provider staff to do? ~ Answer: Review the appropriateness of the service requested 4. When an adult patient is covere...

Your license will be considered to be inactive when you: - correct answer No longer have any appointments On a "participating" health insurance policy issued by a mutual insurance company, dividends paid to policy holders are: - correct answer Not taxable since the IRS treats them as a refund of a portion of the premium paid All of the following are true regarding a non-contributory employer group medical expense insurance policy EXCEPT: - correct answer Premiums must be paid entirely...