Medicare Parts C & D General Compliance Questions and Answers | Latest Version | 2024/2025 | Correct & Verified
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Module
Medicare Parts C & D General Compliance
Institution
Medicare Parts C & D General Compliance
Medicare Parts C & D General
Compliance Questions and Answers |
Latest Version | 2024/2025 | Correct &
Verified
What is required from Medicare Advantage (Part C) plans to remain compliant with CMS
regulations?
They must provide an adequate network of providers to meet the needs of benefic...
Medicare Parts C & D General
Compliance Questions and Answers |
Latest Version | 2024/2025 | Correct &
Verified
What is required from Medicare Advantage (Part C) plans to remain compliant with CMS
regulations?
✔✔They must provide an adequate network of providers to meet the needs of beneficiaries.
What must Medicare Part D sponsors do to prevent fraud, waste, and abuse?
✔✔Implement a compliance program that includes policies to prevent, detect, and correct fraud
and abuse.
How can Medicare beneficiaries report suspected fraud or non-compliance?
✔✔By contacting the Medicare fraud hotline or the plan sponsor.
What is the coverage gap in Medicare Part D also known as?
✔✔The “donut hole” where beneficiaries may face higher out-of-pocket costs.
1
, What is the role of a Medicare Compliance Officer?
✔✔To oversee the implementation of compliance policies and ensure the organization adheres to
CMS regulations.
What happens when a beneficiary enters the catastrophic coverage phase in Medicare Part D?
✔✔They pay significantly lower costs for medications after reaching a certain spending limit.
What is a Medicare formulary?
✔✔A list of prescription drugs covered by a Medicare Part D plan.
What is the purpose of the Medicare star rating system?
✔✔To assess the quality and performance of Medicare Advantage and Part D plans.
What must a Medicare Part C plan provide to ensure compliance with beneficiary needs?
✔✔It must offer an adequate network and ensure that beneficiaries can access necessary services
in a timely manner.
How do Medicare Advantage plans differ from Original Medicare?
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