Dec 26-refresher Activity 1

40 Questions | Total Attempts: 68

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Dec 26-refresher Activity 1

Questions and Answers
  • 1. 
    Where would you click if you wanted to pull up the history on one individual?
    • A. 

      Case Information Tab

    • B. 

      History Tab

    • C. 

      Recipient’s Name

    • D. 

      Span information

  • 2. 
    Was this Good Cause request approved or denied?
    • A. 

      Approved

    • B. 

      Denied

  • 3. 
    What does this icon mean?
    • A. 

      Updates

    • B. 

      Plan Change

    • C. 

      Enrollment

    • D. 

      Special Condition

  • 4. 
    What date indicates an open end date?
    • A. 

      00/00/0000

    • B. 

      11/30/2014

    • C. 

      12/31/2014

    • D. 

      12/31/2299

  • 5. 
    What department is this member receiving their Medicaid through?
    • A. 

      Social Security Administration

    • B. 

      Department of Elder Affairs

    • C. 

      Department of Children and Families

    • D. 

      Agency of Healthcare Administration

  • 6. 
    Which Special Conditions are active?
    • A. 

      HomeSafenet and Children's Medical Services

    • B. 

      Children's Medical Services

    • C. 

      HomeSafenet

  • 7. 
    What information should be used to search for cases in FMMIS? 
    • A. 

      Address, DOB, or card control number.

    • B. 

      Full name, DOB, or address.

    • C. 

      Recipient ID, Social Security number, or gold card number.

    • D. 

      Full name, social security number, or recipient ID.

  • 8. 
    Caller is locked in and says: " I never picked this plan!  You all put me in it!  My doctor, that I really like, doesn't take this plan and has never taken it!  I've been with the same doctor for years, I don't want to change."  Which GC would apply?
    • A. 

      GC1

    • B. 

      GC8

    • C. 

      GC11

    • D. 

      GC9

  • 9. 
    Caller is locked in and says:  "I have HIV and my doctor told me to change to Clear Health Alliance/ Positive HealthCare, I need that to start soon because all of my new specialists take that plan."  Which GC would apply?
    • A. 

      GC17

    • B. 

      GC4

    • C. 

      GC9

    • D. 

      GC5

  • 10. 
    Did the member below choose the health plan or were they auto assigned? 
    • A. 

      Member chose health plan.

    • B. 

      Member was auto assigned.

  • 11. 
    Caller is locked in and says: "I called last month during my open enrollment to change my plan, but my doctor says my plan is still the same. The agent I talked to said I would get a confirmation letter and information from my new plan, but I have yet to recieve anything."  You look and there was a call for a plan change, but no change was processed by the system. How do you proceed?
    • A. 

      Provide the call with the next open enrollment dates.

    • B. 

      Call a supervisor for approval to use a GC1610.

    • C. 

      Call a supervisor for approval to use a GC1612.

    • D. 

      Refer to the AHCA Medicaid Helpline for further assistance.

  • 12. 
    Recipients CAN enroll into PACE under Medicaid Pending.
    • A. 

      True

    • B. 

      False

  • 13. 
    To complete a plan change from PACE into a LTC plan, the recipient must
    • A. 

      Complete the plan change online.

    • B. 

      Call SSA.

    • C. 

      Call the Elder Helpline.

    • D. 

      Call the SMMC line to request a plan change.

  • 14. 
    PACE is...
    • A. 

      A Medicaid program that helps elders with financial needs.

    • B. 

      A Medicare and Medicaid program that helps people meet their health needs in the community instead of going to a nursing home or other care facility.

    • C. 

      A Medicare program that helps elders meet their LTC needs in the community instead of going to a facility.

    • D. 

      A Medicare and Medicaid program that helps people receive their health needs from any facility in their region.

  • 15. 
    Which 'Level of Care' indicator(s) allow recipients to request enrollment into PACE?
    • A. 

      PACE

    • B. 

      LTCN

    • C. 

      LTCC

    • D. 

      PACE and LTCN

  • 16. 
    Before the LTC cut-off date, if a LTC auto-assignment has processed and the caller does not want that plan, how should the agent proceed?
    • A. 

      The agent should place the request on the discrepancy log.

    • B. 

      The agent should confirm the auto-assignment and explain that no change can be made at this time.

    • C. 

      The agent should tell the caller to call back after the cut-off date.

    • D. 

      The agent should process the change through the wizard.

  • 17. 
    When is the cut-off day for MMA?
    • A. 

      The cut-off day is the Thursday before the 2nd to the last Saturday of every month.

    • B. 

      The cut-off day is the second to the last day of the month.

    • C. 

      The cut-off is immediately after the green check mark appears in HealthTrack.

    • D. 

      The cut-off is the last day of the month.

  • 18. 
    MMA plans must provide continuity of care for up to _________ days.
    • A. 

      90

    • B. 

      30

    • C. 

      180

    • D. 

      60

  • 19. 
    Caller states:  "I just started my new plan and just remembered I have an appointment with my old doctor for a procedure.  What should I do?" How should you proceed? 
    • A. 

      Tell the caller the appointment needs to be cancelled and and re-scheduled with the new plan.

    • B. 

      Explain Continuity of Care and refer to the new plan for more information.

    • C. 

      Tell the caller the previous plan will cover services for up to 60 days.

    • D. 

      Tell the caller the appointment will not be covered because the provider is not part of the MMA plan.

  • 20. 
    "I used to have a young lady come out to the house and help me with bathing and getting dressed.  I can't move from the waist down, so its really hard for me to do everything on my own." Which covered service is the recipient referring to? 
    • A. 

      Homemaker Services

    • B. 

      Personal Care

    • C. 

      Hospice

    • D. 

      Caregiver Training

  • 21. 
    "I have to use a walker now because my right hip keeps dislocating.  I fell in the shower the other day and couldn't get up.  I need those bars put on my bathroom so I can hold myself up."Which covered service is the recipient referring to?
    • A. 

      Home Accessibility Adaptation Services

    • B. 

      Hospice

    • C. 

      Respite Care

    • D. 

      Caregiver Training

  • 22. 
    "My father lives on his own and has become very forgetful.  He can do most things on his own but still needs someone around just to help and watch over him.  The other day, he almost burnt the house down because he thought the oven was the dryer.  I'm very worried about him being alone during the day." Which covered service is the recipient referring to?
    • A. 

      Care Coordination/Case Management

    • B. 

      Adult Companion Care

    • C. 

      Personal Care

    • D. 

      Assisted Living

  • 23. 
    "My grandfather has Crohn's Disease and he has to be very careful about what he eats.  His stomach is very sensitive to a lot of foods.  I take care of him, but I'm not sure what type of food is right for him.  I don't want his condition to worsen because I'm not giving him the right foods."  Which covered service is the recipient referring to?
    • A. 

      Home Delivered Meals

    • B. 

      Hospice

    • C. 

      Personal Care

    • D. 

      Nutritional Assessment/Risk Reduction Services

  • 24. 
    "My neighbor Sue helps me during the day.  She cooks for me and helps me around the house.  I really appreciate her help, but she will be going out of town for a week.  I won't have anyone to help me until she gets back." Which covered service is the recipient referring to?   
    • A. 

      Assistive Care Services

    • B. 

      Attendant Care

    • C. 

      Homemaker Services

    • D. 

      Personal Care

  • 25. 
    Why is the recipient listed below Excluded from enrolling into a LTC plan?
    • A. 

      Recipient is receiving Medicaid from the Social Security Administration.

    • B. 

      Recipient has APD: IC meaning they are currently incarcerated.

    • C. 

      Medicaid ended on 5/1/2010.

    • D. 

      Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.

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