In the cms star - Study guides, Class notes & Summaries
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2024 Anthem Administrative Guidelines Exam
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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...
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UHC Ethics & Compliance 2023-2024 Latest Update(Graded A+)
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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...
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UHC Ethics & Compliance exam 2023 with 100% correct answers
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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...
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CDEO Chapter 8 All Possible Questions and Answers with complete solution
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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...
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CRC Exam Questions and Answers 100% Pass
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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 ...
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CRC Exam Questions and Answers 100% Pass
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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 ...
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CRC Exam (Questions & Answers) Passed!!
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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...
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CDEO Chapter 8 Questions & Answers (GRADED A+)
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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...
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UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 3 |A+ GRADE
- Exam (elaborations) • 18 pages • 2023
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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...
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UHC Midterm Exam Well Answered 100% 2024.
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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 ...
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