Dec 26-refresher Activity 1

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  • 1/40 Questions

    Where would you click if you wanted to pull up the history on one individual?

    • Case Information Tab
    • History Tab
    • Recipient’s Name
    • Span information
Please wait...
About This Quiz

This quiz tests knowledge on Medicaid service management, including history tracking, request approval, and understanding special conditions.

Dec 26-refresher Activity 1 - Quiz

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

    Was this Good Cause request approved or denied?

    • Approved

    • Denied

    Correct Answer
    A. Approved
    Explanation
    The Good Cause request was approved.

    Rate this question:

  • 3. 
    What does this icon mean? - ProProfs

    What does this icon mean?

    • Updates

    • Plan Change

    • Enrollment

    • Special Condition

    Correct Answer
    A. Enrollment
    Explanation
    The icon represents enrollment. It is commonly used to indicate the process of signing up or registering for a program or service. This could refer to enrolling in a course, joining a membership, or becoming a participant in an event or activity. The icon may be used to prompt users to take action and complete the enrollment process.

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  • 4. 

    What date indicates an open end date?

    • 00/00/0000

    • 11/30/2014

    • 12/31/2014

    • 12/31/2299

    Correct Answer
    A. 12/31/2299
    Explanation
    The date 12/31/2299 indicates an open end date because it is the latest date provided among the options. The year 2299 implies that there is no specific end date set, suggesting that the event or situation will continue indefinitely.

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

    What department is this member receiving their Medicaid through?

    • Social Security Administration

    • Department of Elder Affairs

    • Department of Children and Families

    • Agency of Healthcare Administration

    Correct Answer
    A. Department of Children and Families
    Explanation
    This member is receiving their Medicaid through the Department of Children and Families.

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  • 6. 
    Which Special Conditions are active? - ProProfs

    Which Special Conditions are active?

    • HomeSafenet and Children's Medical Services

    • Children's Medical Services

    • HomeSafenet

    Correct Answer
    A. HomeSafenet
    Explanation
    The special condition that is active is HomeSafenet. This is indicated by the fact that it is listed as an answer option and there is no mention of any other special condition being active.

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  • 7. 

    What information should be used to search for cases in FMMIS? 

    • Address, DOB, or card control number.

    • Full name, DOB, or address.

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

    • Full name, social security number, or recipient ID.

    Correct Answer
    A. Recipient ID, Social Security number, or gold card number.
    Explanation
    To search for cases in FMMIS, the information that should be used includes the Recipient ID, Social Security number, or gold card number. These are the specific identifiers that can be used to locate and retrieve relevant cases from the system.

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  • 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?

    • GC1

    • GC8

    • GC11

    • GC9

    Correct Answer
    A. GC9
    Explanation
    The caller is expressing dissatisfaction with being enrolled in a plan that they claim they did not choose. They also mention that their preferred doctor does not accept the plan and they do not want to switch doctors. This situation aligns with GC9, which states that the caller wants to keep their current doctor and does not want to switch.

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  • 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?

    • GC17

    • GC4

    • GC9

    • GC5

    Correct Answer
    A. GC17
    Explanation
    The correct answer is GC17. This GC (General Condition) states that a customer who is locked into a contract and has a medical condition can switch to a new plan if their doctor advises it and the new plan covers their specialists. In this case, the caller has HIV and their doctor has recommended switching to Clear Health Alliance/Positive HealthCare because their new specialists accept that plan. Therefore, GC17 would apply in this situation.

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

    Did the member below choose the health plan or were they auto assigned? 

    • Member chose health plan.

    • Member was auto assigned.

    Correct Answer
    A. Member was auto assigned.
    Explanation
    The correct answer is "Member was auto assigned." This means that the member did not actively choose the health plan but was instead assigned to one automatically.

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  • 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?

    • Provide the call with the next open enrollment dates.

    • Call a supervisor for approval to use a GC1610.

    • Call a supervisor for approval to use a GC1612.

    • Refer to the AHCA Medicaid Helpline for further assistance.

    Correct Answer
    A. Call a supervisor for approval to use a GC1610.
    Explanation
    The caller states that they called last month to change their plan during open enrollment, but their doctor says their plan is still the same. The caller also mentions that the agent they spoke to promised a confirmation letter and information from the new plan, but they haven't received anything yet. Upon checking, it is found that although there was a call for a plan change, no change was processed by the system. In this situation, calling a supervisor for approval to use a GC1610 would be the appropriate course of action. This suggests that the GC1610 is a tool or process that can be used to rectify the situation and process the plan change for the caller.

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  • 12. 

    Recipients CAN enroll into PACE under Medicaid Pending.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Recipients can enroll into PACE under Medicaid Pending, meaning that individuals who have applied for Medicaid but are still waiting for their application to be approved can still enroll in the PACE program. This allows them to receive the necessary healthcare services and support while their Medicaid eligibility is being determined.

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  • 13. 

    To complete a plan change from PACE into a LTC plan, the recipient must

    • Complete the plan change online.

    • Call SSA.

    • Call the Elder Helpline.

    • Call the SMMC line to request a plan change.

    Correct Answer
    A. Call the Elder Helpline.
    Explanation
    To complete a plan change from PACE into a LTC plan, the recipient must call the Elder Helpline. This suggests that the Elder Helpline is the appropriate channel for requesting a plan change in this scenario. It implies that the recipient cannot complete the plan change online or through other phone lines such as SSA or SMMC.

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  • 14. 

    PACE is...

    • A Medicaid program that helps elders with financial needs.

    • 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.

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

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

    Correct Answer
    A. 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.
    Explanation
    PACE, which stands for Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program that aims to assist individuals in meeting their health needs within the community rather than being admitted to a nursing home or another care facility. This program provides comprehensive medical and social services to eligible individuals, allowing them to receive the necessary care and support while remaining in their own homes and communities.

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  • 15. 

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

    • PACE

    • LTCN

    • LTCC

    • PACE and LTCN

    Correct Answer
    A. PACE
    Explanation
    Recipients are allowed to request enrollment into PACE. This is indicated by the option "PACE" in the given answer choices.

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  • 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?

    • The agent should place the request on the discrepancy log.

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

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

    • The agent should process the change through the wizard.

    Correct Answer
    A. The agent should process the change through the wizard.
    Explanation
    If a caller does not want the LTC auto-assignment plan before the cut-off date, the agent should process the change through the wizard. This means that the agent should use the appropriate software or tool to make the necessary changes to the caller's plan. This ensures that the caller's preferences are taken into account and that the appropriate plan is assigned to them.

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  • 17. 

    When is the cut-off day for MMA?

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

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

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

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

    Correct Answer
    A. The cut-off is the last day of the month.
    Explanation
    The correct answer is that the cut-off is the last day of the month. This is supported by the statement "The cut-off day is the second to the last day of the month." The other options provided in the question are incorrect as they mention different cut-off days, such as the Thursday before the 2nd to the last Saturday of every month or immediately after the green check mark appears in HealthTrack. Therefore, the last day of the month is the correct cut-off day for MMA.

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  • 18. 

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

    • 90

    • 30

    • 180

    • 60

    Correct Answer
    A. 60
    Explanation
    MMA plans must provide continuity of care for up to 60 days. This means that individuals enrolled in MMA plans are guaranteed access to necessary medical services for a period of 60 days, ensuring that their healthcare needs are consistently met. This provision aims to promote and maintain the quality and consistency of care for MMA plan beneficiaries.

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  • 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? 

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

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

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

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

    Correct Answer
    A. Explain Continuity of Care and refer to the new plan for more information.
    Explanation
    The correct answer is to explain Continuity of Care and refer to the new plan for more information. This is the appropriate response because Continuity of Care ensures that individuals can continue to receive care from their previous healthcare provider even after switching to a new plan. By explaining this concept to the caller and referring them to the new plan for more information, you can help them understand their options and make necessary arrangements for their appointment.

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  • 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? 

    • Homemaker Services

    • Personal Care

    • Hospice

    • Caregiver Training

    Correct Answer
    A. Personal Care
    Explanation
    The recipient is referring to the covered service of Personal Care. This service involves assistance with bathing and getting dressed, which is exactly what the recipient mentioned in their statement. Personal Care is specifically designed to help individuals who have difficulty performing these tasks on their own, making it the appropriate answer in this context.

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  • 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?

    • Home Accessibility Adaptation Services

    • Hospice

    • Respite Care

    • Caregiver Training

    Correct Answer
    A. Home Accessibility Adaptation Services
    Explanation
    The recipient is referring to Home Accessibility Adaptation Services. They mention needing bars put in their bathroom to hold themselves up, indicating a need for modifications to their home to make it more accessible and safe for them to navigate with their walker.

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  • 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?

    • Care Coordination/Case Management

    • Adult Companion Care

    • Personal Care

    • Assisted Living

    Correct Answer
    A. Adult Companion Care
    Explanation
    The recipient is referring to Adult Companion Care. This service involves having someone around to help and watch over the individual who is becoming forgetful and needs assistance with daily tasks. Adult Companion Care provides companionship and supervision to ensure the safety and well-being of the individual.

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  • 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?

    • Home Delivered Meals

    • Hospice

    • Personal Care

    • Nutritional Assessment/Risk Reduction Services

    Correct Answer
    A. Nutritional Assessment/Risk Reduction Services
    Explanation
    The recipient is referring to Nutritional Assessment/Risk Reduction Services because they are unsure about what type of food is right for their grandfather who has Crohn's Disease. They want to make sure they are giving him the right foods to prevent his condition from worsening.

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  • 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?   

    • Assistive Care Services

    • Attendant Care

    • Homemaker Services

    • Personal Care

    Correct Answer
    A. Homemaker Services
    Explanation
    The recipient is referring to Homemaker Services. This is evident from the statement that Sue helps with cooking and helping around the house. Homemaker Services typically involve assistance with household tasks such as meal preparation, cleaning, and other chores related to maintaining the household.

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

    Why is the recipient listed below Excluded from enrolling into a LTC plan?

    • Recipient is receiving Medicaid from the Social Security Administration.

    • Recipient has APD: IC meaning they are currently incarcerated.

    • Medicaid ended on 5/1/2010.

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

    Correct Answer
    A. Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.
    Explanation
    The recipient is excluded from enrolling into a LTC (Long-Term Care) plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities. This indicates that they are already receiving the necessary care and support in their current living arrangement, so enrolling in a LTC plan would not be necessary or appropriate.

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  • 26. 
    What does the "T" shown for the recipient's LTC coverage mean ? - ProProfs

    What does the "T" shown for the recipient's LTC coverage mean ?

    • The recipient's LTC coverage has been terminated and they are no longer receiving services.

    • The recipient experienced a temporary loss and must pay for services until coverage is reinstated.

    • The recipient has experienced a temporary loss and will continue services at no charge for 60 days.

    • The recipient is not eligible to be enrolled into a LTC plan

    Correct Answer
    A. The recipient has experienced a temporary loss and will continue services at no charge for 60 days.
  • 27. 

    Recipients that enroll through Med Pending and start services

    • Cannot change the plan while in Med Pending.

    • May be billed for services if Medicaid is denied.

    • May disenroll.

    • All of the above.

    Correct Answer
    A. All of the above.
    Explanation
    The correct answer is "All of the above" because recipients who enroll through Med Pending and start services cannot change their plan while in Med Pending, they may be billed for services if Medicaid is denied, and they may also disenroll.

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  • 28. 

    What is the LTC Program?

    • The LTC Program is a program that provides services to women and children.

    • The LTC Program is a program that provides services to the terminally ill.

    • The LTC Program is a program that provides long-term care services to elder and disabeld adult enrollees.

    • The LTC Program is a program that only caters to the elderly.

    Correct Answer
    A. The LTC Program is a program that provides long-term care services to elder and disabeld adult enrollees.
    Explanation
    The correct answer is the LTC Program is a program that provides long-term care services to elder and disabled adult enrollees. This answer is supported by the information given in the question, which states that the LTC Program provides services to elder and disabled adult enrollees. This indicates that the program is specifically designed to cater to the long-term care needs of elderly individuals and disabled adults.

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  • 29. 
    Why is the recipient below categorized as Voluntary? - ProProfs

    Why is the recipient below categorized as Voluntary?

    • She has (LTCC) indicator next to her level of care.

    • She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.

    • She has ( MWA ) ACWM.

    • She has APD: WL meaning she is on the Weight Loss Waiver Program.

    Correct Answer
    A. She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.
    Explanation
    The recipient is categorized as Voluntary because she has APD: WL, which stands for Agency for Persons with Disabilities Waitlist. This indicates that she voluntarily joined the waitlist for the Agency for Persons with Disabilities, suggesting that she willingly sought out the services provided by this agency.

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  • 30. 

    A worker for the Department of Children and Families or Community Based Care calls. How do you proceed?

    • Inform the caller that you are not allowed to speak with any agencies and instruct them to have the member call back.

    • Document the callers Name, DOB, last 5 of SSN, and Certification or License Number and continue with the call.

    • Document the caller's Name, Agency & Title, Work Phone Number, Statement of Authority and continue with the call.

    Correct Answer
    A. Document the caller's Name, Agency & Title, Work Phone Number, Statement of Authority and continue with the call.
    Explanation
    The correct answer is to document the caller's Name, Agency & Title, Work Phone Number, Statement of Authority and continue with the call. This is the appropriate response because it allows the worker to gather necessary information about the caller's identity and authority before proceeding with the call. This ensures that the worker is speaking with a legitimate representative from the Department of Children and Families or Community Based Care, and helps maintain the confidentiality and security of the information being discussed.

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  • 31. 
    Which box would you check to enroll into a medical plan? - ProProfs

    Which box would you check to enroll into a medical plan?

    • LTC

    • Better Health

    • MMA

    • Humana Medical Plan

    Correct Answer
    A. MMA
    Explanation
    MMA stands for Medicare Advantage, which is a type of medical plan offered by private insurance companies that provides Medicare benefits. Therefore, checking the box for MMA would indicate enrollment into a medical plan.

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  • 32. 
    What information can be found by clicking the icon below in HealthTrack? - ProProfs

    What information can be found by clicking the icon below in HealthTrack?

    • Medicaid gold card number

    • Eligibility Span

    • Call history

    • Case documentation

    Correct Answer
    A. Eligibility Span
    Explanation
    By clicking the icon below in HealthTrack, you can find information about the eligibility span. This means that you can access details regarding the period of time for which an individual is eligible for Medicaid benefits. It may include the start and end dates of their eligibility, allowing healthcare providers to determine if the individual is currently eligible for Medicaid coverage.

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  • 33. 
    The recipient calls in on 10/17/2014 to make a plan change. The agent must inform the recipient that no plan change can be made. What was the last day the member could have changed plans without using a GC reason? - ProProfs

    The recipient calls in on 10/17/2014 to make a plan change. The agent must inform the recipient that no plan change can be made. What was the last day the member could have changed plans without using a GC reason?

    • 02/12/2015

    • 04/16/2015

    • 07/30/2014

    • 02/13/2015

    Correct Answer
    A. 07/30/2014
    Explanation
    The correct answer is 07/30/2014. This is because the recipient calls in on 10/17/2014 to make a plan change, which means they are already past the date of 07/30/2014. Therefore, no plan change can be made without using a GC reason.

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  • 34. 

    If a caller states they want to see if they are eligible for LTC and you look in HealthTrack and the caller has active MMA coverage, where would you refer the caller?

    • DCF

    • AHCA

    • Elder Helpline

    • SSI

    Correct Answer
    A. Elder Helpline
    Explanation
    If a caller states they want to see if they are eligible for LTC (Long-Term Care) and they have active MMA (Medicaid Managed Care) coverage, they would be referred to the Elder Helpline. The Elder Helpline is a resource that provides information and assistance regarding long-term care services for the elderly. Since the caller already has active MMA coverage, the Elder Helpline would be the appropriate referral to help them navigate and access the necessary long-term care services they may be eligible for.

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  • 35. 
    How is this member currently receiving their services? - ProProfs

    How is this member currently receiving their services?

    • Medicaid Reform HMO

    • FFS/Straight Medicaid

    • Medipass

    • This recipient does not have active Medicaid.

    Correct Answer
    A. FFS/Straight Medicaid
    Explanation
    The member is currently receiving their services through FFS/Straight Medicaid.

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  • 36. 

    PACE Plans will be available to:

    • Recipients 18 years or older that qualify for Long-term Care services.

    • All recipients living in Dade County that have a nursing home level of care.

    • Recipients with a PACE level of care, who are 55 years or older, and live near a PACE region.

    • Recipients that receive SSI, are disabled, and are live in certain zip codes.

    Correct Answer
    A. Recipients with a PACE level of care, who are 55 years or older, and live near a PACE region.
    Explanation
    This answer is correct because it specifies the specific criteria that must be met in order for recipients to be eligible for PACE Plans. The answer states that recipients must have a PACE level of care, be 55 years or older, and live near a PACE region. This means that recipients who meet these criteria will be eligible for PACE Plans.

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  • 37. 

    Agent says: "I have a recipient on the phone that is being auto-assigned to Freedom Health, but they have a TPL 19 and the caller is stating they should not have to choose a plan." What should you do?

    • Place this on the discrepancy log.

    • Escalate this to Marsha and Lisa because the recipient should be excluded with TPL 19

    • Tell the caller that due to the type of Medicaid that is on file, they will need to select a plan.

    • Verify if the recipient has a special condition on file to determine if the caller is eligible to enroll with that plan.

    Correct Answer
    A. Tell the caller that due to the type of Medicaid that is on file, they will need to select a plan.
    Explanation
    Based on the information provided, the correct course of action is to inform the caller that they will need to select a plan due to the type of Medicaid that is on file. This suggests that the caller's Medicaid coverage requires them to choose a plan, regardless of their preference or the auto-assignment from Freedom Health.

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  • 38. 

    This recipient is going to be Auto-Assigned to Freedom Health (Specialty Plan). The recipient wants this plan but it is not showing up in the wizard for you to enroll the recipient. What should you do?

    • Submit a supervisor task for further research.

    • If the recipient wants the auto-assignment into Freedom, select accept assignment.

    • Place this on the discrepancy log for processing.

    Correct Answer
    A. If the recipient wants the auto-assignment into Freedom, select accept assignment.
    Explanation
    If the recipient wants the auto-assignment into Freedom, the correct action to take is to select accept assignment. This means that the recipient will be enrolled in the Freedom Health (Specialty Plan) as desired.

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  • 39. 
    Which tab below would indicate if the recipient has been pre-approved for CMS? - ProProfs

    Which tab below would indicate if the recipient has been pre-approved for CMS?

    • Special Conditions

    • Level of Care

    • Waiver Program

    • Eligibility

    Correct Answer
    A. Special Conditions
    Explanation
    The Special Conditions tab would indicate if the recipient has been pre-approved for CMS. This tab is likely to contain information about any specific conditions or requirements that the recipient needs to meet in order to be eligible for CMS. It may include details about any medical or financial criteria that need to be met, as well as any documentation or paperwork that needs to be submitted. By checking the Special Conditions tab, one can determine if the recipient has been pre-approved for CMS or if there are any additional steps or requirements that need to be fulfilled.

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  • 40. 

    Continuity of Care would apply to which of the following?

    • When a recipient changes from one MMA plan to another MMA plan.

    • When a recipient changes from FFS to a MMA plan.

    • All of the Above

    Correct Answer
    A. All of the Above
    Explanation
    Continuity of Care refers to the seamless and uninterrupted provision of healthcare services to patients when there are changes in their healthcare plans. In the given options, both scenarios involve a recipient transitioning from one plan to another, which could disrupt their healthcare services. Therefore, in both cases, Continuity of Care would apply to ensure that the recipient receives the necessary care without any interruptions. Hence, the correct answer is "All of the Above."

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Quiz Review Timeline (Updated): Aug 24, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Aug 24, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Dec 19, 2014
    Quiz Created by
    AHSFLTrainer

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