Medicare beneficiaries - Study guides, Class notes & Summaries

Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? - ANSWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney tr...

CRCR Exam Prep 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 patient accounts department? - correct answer Ho...

Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? correct answersDr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the Medicare rate. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an at...

CPCO EXAM REVIEW QUESTIONS AND ANSWERS, 100% ACCURATE. VERIFIED. The OIG consists of 6 departments: - -1.Immediate OIG — responsible for the overall fulfillment of the OIG's mission and for promoting effective management and quality of the agency's processes and products. 2.Office of Audit Services — performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance. 3.Office of Evaluation and Inspections — conducts national evaluations...

Steps used to control costs of managed care include: correct answers Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct answers Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage correct answers HMO Conventional PPO and POS HDHP/SO plans - high-deductible health...

AHIP 2024 Certification Version 2 All New Qs & As for A++ Exam - Guaranteed Pass! 1. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollmentin a Medicare prescription drug plan because, although she is entitled to PartA, she is not enrolled under Medicare Part B. What should you tell her? Answer: An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, ...

How should Humana agents respond to Medicare beneficiaries who want to know their new Medicare ID number? - Advise the beneficiary that any questions regarding their new Meidcare ID number must be directed to Medicare. Under which circumstances is it acceptable for an agent to complete an Agent Online Application (AOA) application on behalf of their client? - It is never acceptable under any circumstance for an agent to complete the AOA Application on behalf of their client, even if they re...

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...

AHIP Exam Questions and Answer You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind? Correct Answer: ou may request RSVPs, but you are not permitted to require contact information. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his presc...