2014-QM Fun Quiz 1

1. The HIPAA called in for the customer and secured the call. 30 minutes later the customer came on the line. The BA secured the call with the customer. The customer could not recall the last four digits of their SSN and gave the incorrect phone number. How would you score Secure the Call?

Yes

Major

N/A

Red Flag

The HIPAA already secured the account, so the BA did not need to go through STC with the customer.

Explanation

The HIPAA already secured the account, so the BA did not need to go through STC with the customer.

2. Since the customers are HIPAA reps for each other, MR can answer for MRS on number 4 in the script

True

False

The statement suggests that MR can answer for MRS on number 4 in the script. However, without any context or additional information, it is not clear what "MR" and "MRS" refer to, or what "number 4 in the script" means. Therefore, it is not possible to provide a clear explanation for why the answer is false.

Explanation

The statement suggests that MR can answer for MRS on number 4 in the script. However, without any context or additional information, it is not clear what "MR" and "MRS" refer to, or what "number 4 in the script" means. Therefore, it is not possible to provide a clear explanation for why the answer is false.

3. The ADP read all of the benefits verbatim, but did not read the headers for Doctor and Hospital Choice or Emergency Care. What grade would you give for those line items?

Yes

Minor

Major

Red Flag

Coach

The given answer "Yes" suggests that the ADP did read the headers for Doctor and Hospital Choice or Emergency Care. This indicates that the ADP correctly understood and acknowledged these line items.

Explanation

The given answer "Yes" suggests that the ADP did read the headers for Doctor and Hospital Choice or Emergency Care. This indicates that the ADP correctly understood and acknowledged these line items.

4. Call ID 7191059. Grade Secure the Call for the BA.

Yes

Major

N/A

Red Flag

This should be marked N/A and a coaching note could be added. The BA does not need to re-secure the call when it is an internal transfer.

Explanation

This should be marked N/A and a coaching note could be added. The BA does not need to re-secure the call when it is an internal transfer.

5. Call ID 7150253. Timestamp 00:03:27-00:04:20. Grade number 3 on the QM form.

Prohibited Practice

Coach

Red Flag because the BA said 'typically'

not-available-via-ai

Explanation

not-available-via-ai

6. Call ID 6990939. Timestamp 00:07:50 - 00:08:06 What prohibited practice would you use for this?

Claiming that a specific carrier is recommended or endorsed by CMS, Medicare or the Department of Health and Human Services

Use absolute superlatives like asserting that a certain plan is “the best” plan

Mislead, confuse or misrepresent to potential members about Medicare or competitive plans

The prohibited practice in this case would be using absolute superlatives, such as asserting that a certain plan is "the best" plan. This is because it is not allowed to make exaggerated claims or use language that implies superiority or exclusivity when describing a plan. Doing so could mislead or confuse potential members about the actual benefits and options available to them.

Explanation

The prohibited practice in this case would be using absolute superlatives, such as asserting that a certain plan is "the best" plan. This is because it is not allowed to make exaggerated claims or use language that implies superiority or exclusivity when describing a plan. Doing so could mislead or confuse potential members about the actual benefits and options available to them.

7. The customer chose a Medigap Plan N and a Humana PDP. When the BA was transferring the call to an ADP, the line disconnected. The BA noticed that the Medigap plan for some reason, was not in the cart anymore, but the PDP was still there. The BA told the customer to hold on while she put the Medigap plan back in the cart. After she put the plan in the cart again, she transferred the call to an ADP. Since the BA only needed to put one of the plans back in the cart, the BA didn't have to read the MIR.

True

False

Any time the BA has to put a plan in the cart, the MIR must be read.

Explanation

Any time the BA has to put a plan in the cart, the MIR must be read.

8. The ADP read a non-required benefit incorrectly. How would you grade it?

Mark as a minor on the QM form

Since there is nowhere to grade it, coach it

Mark as major on the QM form

Red Flag

The correct answer is "Mark as a minor on the QM form." This is because the ADP (Automated Data Processing) read a non-required benefit incorrectly, which is a minor issue. Therefore, it should be marked as a minor on the Quality Management (QM) form to indicate that it is a small error that does not have a significant impact.

Explanation

The correct answer is "Mark as a minor on the QM form." This is because the ADP (Automated Data Processing) read a non-required benefit incorrectly, which is a minor issue. Therefore, it should be marked as a minor on the Quality Management (QM) form to indicate that it is a small error that does not have a significant impact.

9. The customers are each enrolling into the same MAPD plan. Select what must be done on a joint application. Check ALL that apply.

Read the opening script twice-once to each customer

Authorize each other to assist with the application, number 10 in the Definitions

Read the long term care facility tiers for drug coverage

Get a response from each customer on number 9

On a joint application for enrolling into the same MAPD plan, it is necessary to authorize each other to assist with the application, as mentioned in number 10 of the Definitions. Additionally, it is important to get a response from each customer on number 9.

Explanation

On a joint application for enrolling into the same MAPD plan, it is necessary to authorize each other to assist with the application, as mentioned in number 10 of the Definitions. Additionally, it is important to get a response from each customer on number 9.

Submit

2014-qm Fun Quiz 1