In the cms star - Study guides, Class notes & Summaries

ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process? - ️️Authorization may be obtained by directing a beneficiary to a website to provide consent Agent Harriet Walker has recently begun marketing Medicare Advantage and related products ai...

CBCS Practice Test Questions And Answers Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - ANS history and physical A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits" box has been checked "yes." The checked box indicates which of the following? - ANS The provider receives payment directly from the payer Which of the following do physic...

AHIP Practice Exam Questions and Answers 100% Pass Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? - Correct Answer ️️ -Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug pla...

CRC EXAM QUESTIONS AND ANSWERS 100% PASS Risk Adjustment Data Element - Correct Answer ️️ -Age, Gende, Socioeconomic status, Disability status, Insurance status(Medicaid, dual-eligible,) Claims data elements such as procedure codes, place of service codes, special patient-specific conditions hospice, ESRD RAF - Correct Answer ️️ -Risk Adjustment Factor Scores Three main types of reviews - Correct Answer ️️ -Retrospective, Concurrent and prospective Retrospective - Correct Ans...

How is predictive modeling used in risk adjustment? -:- to determine suspected diagnosis based on data elements. Which of the following data elements are used in predictive modeling? I. DME claims II. Prescription drug events III. Physician claims data IV. Facility claims data a. III and IV b. I, II, and IV c. I, II, and III d. I, II, III, and IV -:- d. I, II, III, and IV What might happen as a result of predictive modeling? 2 0 2 4 / 2 0 2 5 | © copyright | This work may not be...

AHIP PRACTICE EXAM WITH CORRECT ANSWERS Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? - CORRECT ANSWER-Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan throu...

CRC Exam Questions and Answers 100% Pass How is predictive modeling used in risk adjustment? - Correct Answer ️️ -to determine suspected diagnosis based on data elements. Which of the following data elements are used in predictive modeling? I. DME claims II. Prescription drug events III. Physician claims data IV. Facility claims data a. III and IV b. I, II, and IV c. I, II, and III d. I, II, III, and IV - Correct Answer ️️ -d. I, II, III, and IV What might happen as a result ...

UHC Ethics And Compliance Section For Certification Rated A+ What is a servicing agent? ️an inactive, nonemployee who has signed a servicing agreement in order to receive renewal commisions on medicare advantage and prescription drug plan enrollments on or after 1-1-2014. the agent must maintain an active resident license and appointment and pass medicare basics and ethics compliance assessments on an annual basis What does CMS stand for? ️center for medicare and medicaid services ...

Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational? - Yes. Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. You are meeting with Mrs. Hall i...

In which situation may the Medicare Advantage (MA) organization decide to disenroll a member from an MA plan? correct answer: The member calls CMS at 1-800-MEDICARE (Wrong) On October 20, Aries decides to switch his PDP to a Medicare Advantage plan. Aries would like this change to be effective November 1. Which statement is true for Aries? correct answer: He may be able to use a Special Election Period to change plans if he qualifies for one. Janine, currently enrolled in a 3-star plan, ...