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

2024 Anthem Administrative Guidelines Exam I completed all my training on Friday. When will I know I'm ready to sell? - ANS Only after receipt of the confirmation email should arrive on Monday. Training completed one day should be validated the following business day. What tool does BlueCross provide for you to submit notes taken during the meeting with a prospect? - ANS Cavulus If a member chooses to cancel or withdraw an enrollment application or terminate enrollment in a plan o...

Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? - ANSWERSOn the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? - ANSWERSMrs...

Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Mrs. Violet can...

Quality Bonus Payments - TO make quality of care a priority the Affordable Care Act set a requirement that CMS make quality bonus payments to Medicare Advantage plans that earn four or more stars in a five-star quality rating system would receive a bonus payment. Earning fewer than four stars would receive no bonus. Suspect Logic - Many organizations utilize a method such as this one to uncover diagnoses which are likely present but unreported or unknown Chart Reviews - Analysis of the inf...

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 ...

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 ...

How is predictive modeling used in risk adjustment? - 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 - Answer-d. I, II, III, and IV What might happen as a result of predictive modeling? a. Disease management programs b. Concurrent aud...

PREDICTIVE MODELING - ANSWER-is an analytical review of known data elements to establish a hypothesis related to the future health needs of patients or a population of patients Suspect Logic - ANSWER-Many organizations utilize a method such as this one to uncover diagnoses which are likely present but unreported or unknown Chart Reviews - ANSWER-Analysis of the information identified is used to target retrospective reviews to capture any unreported diagnoses Suspect Logic Factors - ANSW...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 3 |A+ GRADE Q: Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)? Answer: Dennis should...

The work we do in the year 2023 regarding STAR measures will result in payment in what year? - Answer 2026 Star ratings is the program that CMS (centers for Medicare and Medicaid services) uses to compare Medicare advantage plans? - Answer True Quality bonus payments and rebates will only be paid to plant scoring/performing at what star rating? - Answer 4+ Improving star ratings is an enterprise wide effort, and we all play a part in improving our scores. Select all the ways that ...