2014 - Qm - Final 1

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Bthorup

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Quizzes Created: 41 | Total Attempts: 28,852

| Attempts: 161

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1/67 Questions

BenefitsFill in the Blank:Medigap Plan N-Covers 100% of Part B coinsurance after you meet your yearly Part ____ deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.
- A
- B
- C
- D

About This Quiz

The 2014 - QM - Final 1 quiz assesses knowledge on proper scripting and disclaimer protocols in customer interactions, focusing on adherence to quality management standards. It evaluates understanding of legal compliance and customer communication.

Quiz Preview

2.

Medigap, page 2 and beyondIf the ADP has to clarify a question on page 4 for the customer and then does not re-state the question, which carrier would that be acceptable for?
- Blue Shield of Maryland
- Aetna
- BCBS of KY
- Humana
- Carefirst BlueCross BlueShield of Maryland
Correct Answer

A. Carefirst BlueCross BlueShield of Maryland

Explanation

If the ADP has to clarify a question on page 4 for the customer and then does not re-state the question, it would be acceptable for Carefirst BlueCross BlueShield of Maryland.

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3.

Sales callsAdjusting the words in the MIR is acceptable as long as it does not change the meaning.
- True
- False
Correct Answer

A. True

Explanation

Adjusting the words in the MIR (Message Impact Ratio) is acceptable as long as it does not change the meaning. This means that salespeople can modify their sales calls to better suit their audience or to emphasize certain points, as long as the overall message remains the same. This allows for flexibility in communication and tailoring the sales pitch to individual customers without compromising the core message.

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4.

BA Prohibited PracticesIf the BA states that the customer's HICN is the same as their social security number with a letter, would this be marked as a Prohibited Practice?
- Yes
- No
Correct Answer

A. Yes

Explanation

If the BA states that the customer's HICN (Health Insurance Claim Number) is the same as their social security number with a letter, it would be marked as a Prohibited Practice. This is because disclosing or using a social security number in conjunction with other identifiers is considered a prohibited practice under HIPAA regulations.

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5.

BA Prohibited PracticesThe BA and the customer do not have a good phone connection so the customer asks the BA to email some information on the plan they are discussing. The BA copies the plan information from the Summary of Benefits and sends it to the customer. Is this a Prohibited Practice?
- Yes
- No
Correct Answer

A. Yes

Explanation

Yes, this is a prohibited practice. The BA is copying and sending plan information from the Summary of Benefits to the customer via email. This violates the rules and regulations set by the organization, as it is not allowed to transmit sensitive information through insecure channels like email. The BA should have found an alternative method to communicate the plan information securely, such as using a secure messaging platform or arranging a face-to-face meeting.

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6.

ADP Prohibited PracticesIs the following scenario a Prohibited Practice and if so, which Prohibited Practice would you use:The ADP told the customer that he works for the Centers of Medicare and Medicaid Services.
- Effectuate, or represent that you have the authority to effectuate or bind, coverage under an insurance policy.
- Misrepresent themselves as an agent of Medicare, Social Security or any agency of the federal government.
- Attempt to solicit (urge or persuade a customer to buy insurance) or negotiate (provide opinions, advice or recommendations on insurance coverage’s or the substantive benefits, terms or conditions of) a contract of insurance.
- Mislead, confuse or misrepresent to potential members about Medicare or competitive plans.
- This statement would not be considered a Prohibited Practice
Correct Answer

A. Misrepresent themselves as an agent of Medicare, Social Security or any agency of the federal government.

Explanation

The statement in the scenario where the ADP tells the customer that he works for the Centers of Medicare and Medicaid Services would be considered a Prohibited Practice. This is because the ADP is misrepresenting themselves as an agent of Medicare, Social Security, or any agency of the federal government.

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7.

Secure the CallMRS is discussing plan options with a BA. Another female asks a question about the Coverage Gap. The BA answers her question without asking who she is or asking the customer if she consents to have this person on the line listening to her enrollment options. Would QM score Secure the Call as Non-Compliant?
- Yes. Everybody on the line must be secured.
- No. This would be treated as implied consent but QM would still coach the BA to ask the customer if they would like that person added as a HIPAA representative
- Yes. The customer would have had to authorize that person prior to this phone call to be their HIPAA representative.
- No. If the other person doesn't have a record in the SSC, then they don't have to be secured.
Correct Answer

A. No. This would be treated as implied consent but QM would still coach the BA to ask the customer if they would like that person added as a HIPAA representative

Explanation

The correct answer is no because although the BA did not explicitly ask for consent, it can be considered as implied consent. However, the QM would still advise the BA to ask the customer if they would like the person added as a HIPAA representative.

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8.

Closing Script and Contact InformationWhen is it acceptable for the BA/ADP to not read the closing script?
- Never
- After completing a Medigap application IF they will also be completing a PDP application and reading the closing script after the PDP
- If it is the end of their shift and they want to go home
- The closing script is not required
Correct Answer

A. After completing a Medigap application IF they will also be completing a PDP application and reading the closing script after the PDP

Explanation

The BA/ADP is only allowed to not read the closing script after completing a Medigap application if they will also be completing a PDP application and reading the closing script after the PDP. This means that if they are going to complete both applications and read the closing script after the PDP, they do not need to read the closing script after completing the Medigap application.

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9.

Application, page 1The customer said their date of birth is 5/31/36. The ADP asked the customer to restate the date of birth but give a four digit year. Which statement is most accurate?
- The ADP knows they will lose points if they do not ask for the four digit year
- The ADP will not lose points if they do not ask for the four digit year
- The ADP is trying to get extra points on their QM form
Correct Answer

A. The ADP will not lose points if they do not ask for the four digit year

Explanation

The ADP will not lose points if they do not ask for the four digit year because the customer's date of birth is already provided as 5/31/36. Although it is standard practice to ask for a four digit year, it is not mandatory in this case as the customer has already stated their date of birth. Therefore, not asking for the four digit year will not result in any penalty or loss of points.

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10.

BenefitsThe ADP must read additional benefits from the Full Summary of Benefits on a HMO-POS plan. What are those benefits?
- Chiropractic Services
- Inpatient Hospital Care/Hospital Stays
- Ambulatory Surgical Center
- Primary Care Physician
- Physical Therapy
- Physician Specialist Services
- Diagnostic Radiological Services
- Ambulance Services
Correct Answer(s)

A. Inpatient Hospital Care/Hospital Stays
A. Primary Care Physician
A. Physician Specialist Services
A. Ambulance Services
11.

BenefitsWhat additional benefits must be read if the customer resides in a nursing home?
- Home Health Care
- Hospice
- Long Term Care Pharmacy Drug Tiers
- Outpatient Rehabilitation Services
- Skilled Nursing Facility (SNF)
Correct Answer

A. Long Term Care Pharmacy Drug Tiers
12.

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Medicare Annual Enrollment Period is from October 7th to December 15th every year.
- This statement would not be considered a Prohibited Practice
- Mislead, confuse, or misrepresent to potential members about Medicare or competitive plans
- Using high pressure sales tactics
- Market or sell plans that a Benefit Advisor is not licensed or appointed for
Correct Answer

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

Explanation

The statement provided does not mislead, confuse, or misrepresent to potential members about Medicare or competitive plans. It simply states the correct information about the Medicare Annual Enrollment Period. Therefore, it would not be considered a Prohibited Practice.

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13.

Closing Script, Contact Information When providing the customer with our contact information, the customer stated that they do not need the TTY number before the BA could provide it. How would this be graded (provided all other information was given correctly)?
- Yes
- Minor
- Major
- N/A
Correct Answer

A. Yes

Explanation

The customer's statement that they do not need the TTY number before it was provided indicates that the BA successfully anticipated and addressed the customer's needs. This demonstrates effective communication and customer service skills, resulting in a positive interaction. Therefore, the answer "Yes" is correct.

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14.

Medigap, page 2 and beyond"Do you intend to replace your current healthcare coverage with this Medicare Supplement policy?"This question is always marked No on each application for every carrier.
- True
- False
Correct Answer

A. False

Explanation

The statement "This question is always marked No on each application for every carrier" is false. The question is asking whether the individual intends to replace their current healthcare coverage with the Medicare Supplement policy. The answer to this question may vary depending on the individual's circumstances and preferences. Some individuals may choose to replace their current coverage, while others may not. Therefore, the answer to this question is not always marked as "No" on every application for every carrier.

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15.

Medigap, page 2 and beyondQM will score line item 41 as a Major if the BA skips the following questions on a guaranteed issue application: Current Age, Height, Weight, BMI.
- True
- False
Correct Answer

A. False

Explanation

The statement is false because according to the given information, if the BA skips the questions about Current Age, Height, Weight, and BMI on a guaranteed issue application, the QM will score line item 41 as a Major. Therefore, the correct answer should be True, not False.

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16.

BenefitsIf the ADP read the entire portion from the HMO-POS section, would QM score them down?
- No. The ADP went above and beyond what they had to read and should not be marked down.
- Yes. The ADP only has to read four benefits as listed in the definitions
- No. As long as long as they read them all accurately.
Correct Answer

A. No. As long as long as they read them all accurately.

Explanation

The correct answer is "No. As long as they read them all accurately." This answer states that the ADP should not be marked down as long as they read all the benefits accurately. It implies that reading more than the required four benefits from the HMO-POS section does not result in a lower QM score.

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17.

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Plan F is the cream of the crop.
- This statement would not be considered a Prohibited Practice
- Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.
- Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.
Correct Answer

A. Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.

Explanation

The given statement, "The Plan F is the cream of the crop," would be considered a Prohibited Practice. This is because it uses an absolute superlative, asserting that Plan F is the best plan. Prohibited Practices include making statements that claim a certain plan is the best or lowest cost, which this statement does.

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18.

Red FlagIs this scenario a Red Flag Situation and if so, which Red Flag would you use on the form?The customer is NOT losing group coverage and has called on December 8th to complete an enrollment into a different drug plan for 2015. The BA submitted an application for the customer thinking that the carrier would accept it because it was only 1 day after the annual enrollment period ended.
- Other
- BA did not transfer to SST when prompted to do so.
- Doing an enrollment when there is not an applicable enrollment period.
- This is not a Red Flag situation
Correct Answer

A. Doing an enrollment when there is not an applicable enrollment period.

Explanation

The correct answer is "Doing an enrollment when there is not an applicable enrollment period." This is because the customer called on December 8th to complete an enrollment into a different drug plan for 2015, which is outside the annual enrollment period. Therefore, the enrollment should not have been processed as there was not an applicable enrollment period for the customer to make changes to their plan.

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19.

Voice Signature, Confirmation NumberWhat are the three parts of the voice signature that the customer must state for it to be valid?Check all that apply.
- Plan Name
- Premium
- Full Name
- Today's date
- The effective date
- They agree
Correct Answer(s)

A. Full Name
A. Today's date
A. They agree

Explanation

The three parts of the voice signature that the customer must state for it to be valid are the Full Name, Today's date, and They agree. The Plan Name, Premium, and Effective Date are not necessary components of the voice signature.

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20.

Closing Script, Contact InformationThe BA/ADP must read the closing script to each customer individually when completing a joint application.
- True
- False
Correct Answer

A. False

Explanation

The given statement is false. The BA/ADP does not need to read the closing script to each customer individually when completing a joint application.

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21.

Medigap, page 2 and beyondIf the question regarding how the customer would prefer to pay the premiums is asked twice on a Medigap application, the ADP/BA may skip it the second time it appears.
- True
- False
Correct Answer

A. True

Explanation

If the question regarding how the customer would prefer to pay the premiums is asked twice on a Medigap application, the ADP/BA may skip it the second time it appears. This means that if the question is repeated, the ADP/BA has the option to not ask it again.

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22.

Medigap, page 2 and beyondIf the ADP does not ask for the AARP membership number on the first page, QM scores Major on number 41 because there is no line item for this question for the AARP membership field.
- True
- False
Correct Answer

A. False

Explanation

The explanation for the answer being False is that the statement in the question suggests that if the ADP (presumably a form or document) does not ask for the AARP membership number on the first page, then the QM (quality management) scores Major on question number 41. However, this does not necessarily mean that the answer is False. It is possible that the QM scores Major on question number 41 in this scenario, making the statement True. Therefore, the given answer is not a correct explanation for the answer being False.

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23.

Sales callsThe customer called and discussed plan options with the BA on Monday. The customer needed more time to decide on a selection and called back on Friday and spoke with the same BA. Would the BA need to read the MIR prior to quoting even if it was read on the initial call?
- Yes
- No
Correct Answer

A. Yes

Explanation

The BA would need to read the MIR prior to quoting even if it was read on the initial call because the customer called back on a different day. It is important for the BA to refresh their memory and ensure they have the most up-to-date information before providing a quote to the customer.

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24.

Sales CallsThe BA read the Medical Information Release after giving two Medigap premiums but did not discuss any plan benefits. Would this be Non-Compliant?
- Yes
- No
Correct Answer

A. Yes

Explanation

The BA's failure to discuss any plan benefits during the sales calls after providing two Medigap premiums indicates non-compliance. It is essential for the BA to inform and discuss the plan benefits with the customers to ensure transparency and compliance with regulations. By not doing so, the BA is not fulfilling their responsibilities and may be violating compliance standards.

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25.

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"The Plan N has no deductibles"
- Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.
- This statement would not be considered a Prohibited Practice
- Using high pressure sales tactics.
- Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.
Correct Answer

A. Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.

Explanation

The statement "The Plan N has no deductibles" would be considered a Prohibited Practice because it conflicts with the information contained within CMS-approved materials. It is misquoting the plan benefits by stating that there are no deductibles when there actually might be.

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26.

Red FlagThe customer must be enrolled in a Medical plan through One Exchange to qualify for his funding.The customer tells the BA that he wants the same individual Medicare Advantage plan he currently has, so the BA enrolled him in the exact same plan. Which Red Flag would you use?
- Gave incorrect funding amount or qualification information
- Enrolled customer into same carrier or plan as individual CMS plan the customer already has
- Other
- Gave incorrect information on AR or AR time frames
- There is nothing wrong with the BA doing this since the customer requested it
Correct Answer

A. Enrolled customer into same carrier or plan as individual CMS plan the customer already has

Explanation

The BA made a mistake by enrolling the customer in the exact same plan that he already has. This is a red flag because it suggests that the BA did not properly assess the customer's needs or provide appropriate guidance. The customer's request does not justify enrolling him in the same plan, as the customer must be enrolled in a Medical plan through One Exchange to qualify for funding.

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27.

Disclaimer, Disclaimer ScriptingIf the call disconnects during the legal disclaimer, is it acceptable for the BA to call the customer back to finish it?
- Yes
- No
Correct Answer

A. No

Explanation

All aspects of an enrollment must be completed on an inbound call

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28.

Closing Script, Contact Information Who is eligible to receive the closing script information on their own?(Select all that apply)
- Authorized representative
- HIPAA
- POA
- Customer
Correct Answer(s)

A. POA
A. Customer

Explanation

The closing script information can be received by both the Power of Attorney (POA) and the customer themselves. The authorized representative and HIPAA are not mentioned in the question as eligible recipients of the closing script information.

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29.

Sales CallsIf an LBS is brought on the line by an ADP and the LBS puts a new plan in the cart, does the LBS have to read the intent to enroll scripting before dropping off the call?
- Yes
- No
Correct Answer

A. Yes

Explanation

The LBS is required to read the intent to enroll scripting before dropping off the call when a new plan is added to the cart. This ensures that the customer is fully informed about the plan and its details before making a decision.

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30.

Opening Script How would you grade the following statement and why?"My name is Fi Schneider, today is Friday July 11th. This call will be recorded. Do I have your permission to record this conversation to confirm your enrollment?"
- Yes- There is nothing wrong with the statement.
- Minor- The BA/ADP did not read the statement verbatim (the year was not stated)
- Major-The BA/ADP skipped part of the statement (the year was not stated)
- N/A
Correct Answer

A. Minor- The BA/ADP did not read the statement verbatim (the year was not stated)

Explanation

The correct answer is "Minor- The BA/ADP did not read the statement verbatim (the year was not stated)". This is because the statement mentioned the day and month but did not include the year, which is part of reading the statement verbatim.

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31.

Sales CallsWhich version of the MIR would not cause the call to be Non-Compliant?The correct statement reads:'As we proceed, you are not required to answer any health or prescription related questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?'
- Coming up, you are not required to answer health or prescription questions. If you do answer those questions, your answers won't affect your eligibility to enroll in a plan.
- I might ask some questions regarding health or prescriptions. You do not have to answer them but I recommend you do.
- Some of the plans will want to know what prescriptions you take and may want to know about your current health. You don't have to answer any questions though because you are guaranteed issue.
- As we move forward, you do not have to answer any prescription or health questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?
- As we proceed, you are required to answer any health or prescription related questions. Your answers will affect your eligibility to enroll in a Medicare plan.
Correct Answer

A. As we move forward, you do not have to answer any prescription or health questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?

Explanation

The correct answer is the one that clearly states that the individual is not required to answer any health or prescription related questions, and that their answers will not affect their eligibility to enroll in a Medicare plan. This statement ensures that the call is compliant because it does not put any pressure on the individual to answer the questions and does not imply that their eligibility will be affected by their answers.

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32.

ADP Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"Humana is a better company than Health Net. You should have chosen Humana."
- Recommend, advise, or urge a potential insurance customer or a current policyholder to choose one insurance carrier over another
- This statement would not be considered a Prohibited Practice
- Effectuate, or represent that you have the authority to effectuate or bind, coverage under an insurance policy
- Explain, interpret or offer opinions, advice or recommendations on, insurance coverages, exposures, limits, premiums, rates, deductibles, payment plans, or any other insurance contract, or potential insurance contract, terms to any potential insurance customer
Correct Answer

A. Recommend, advise, or urge a potential insurance customer or a current policyholder to choose one insurance carrier over another

Explanation

The given statement "Humana is a better company than Health Net. You should have chosen Humana" falls under the category of recommending, advising, or urging a potential insurance customer or a current policyholder to choose one insurance carrier over another. This is considered a prohibited practice because it involves promoting one company over another, which may be misleading or unfair to the customers.

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33.

Application, page 1The customer's name is William George Johnson. On the application, he stated his first name as 'George' and on the application it appears as 'William'. What will QM do for number 28?
- Minor because it was done but not done correctly
- Check with a supervisor before scoring it down
- Yes, because George is his middle name
- Major because the application doesn't match what was heard on the recording
Correct Answer

A. Check with a supervisor before scoring it down

Explanation

The correct answer is to check with a supervisor before scoring it down. This is because there is a discrepancy between the customer's stated first name and the name that appears on the application. To ensure accuracy and avoid making a mistake, it is important to consult a supervisor for guidance before taking any action.

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34.

Secure the CallDuring the sales portion of the call, the line disconnects. The customer calls back within 2 minutes and is routed to the same BA.The BA does not have to secure the call if the customer calls right back and is routed to the same BA.
- True
- False
Correct Answer

A. False

Explanation

The BA does have to secure the call even if the customer calls back within 2 minutes and is routed to the same BA.

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35.

BenefitsADP/BA is completing a Medigap Plan N. What benefits are they required to read?
- Doctor and Hospital Choice-“You can go to any doctor, supplier, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients.”
- Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.
- Part B Excess
- All of the Above
- None of the Above-Benefits are not required to be read on any Medigap plans
Correct Answer

A. Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.

Explanation

The correct answer is "Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits." This is the correct answer because it accurately describes the specific benefits related to medical expenses that are required to be read for a Medigap Plan N. It mentions the coverage for Part B coinsurance, the yearly deductible, and the additional copayments for office visits and ER visits.

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36.

BenefitsBA's are allowed to skip benefits for a Plan F, but ADPs are not.
- True
- False
Correct Answer

A. False

Explanation

This statement is false. Both BenefitsBA's and ADPs are allowed to skip benefits for a Plan F.

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37.

Opening ScriptThe BA/ADP asks for permission to record the conversation on a joint application- Mr. Wayne says "Yes you do.", however Mrs. Wayne says nothing. How should this be graded?
- Yes
- Major- The BA/ADP skipped this line completely.
- Minor- The ADP/BA did not obtain consent to record the call.
Correct Answer

A. Minor- The ADP/BA did not obtain consent to record the call.

Explanation

The correct answer is "Minor- The ADP/BA did not obtain consent to record the call." This is because Mrs. Wayne did not provide explicit consent to record the conversation, which is a requirement. Even though Mr. Wayne said "Yes you do," it does not cover both parties and therefore the ADP/BA did not obtain proper consent.

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38.

Sales CallsThe customer told the BA they were very helpful and answered all of their questions. Would the BA still need to ask if the customer had additional questions prior to transferring to an ADP?
- Yes
- No
Correct Answer

A. No

Explanation

The customer already mentioned that they had all their questions answered and found the BA to be helpful. Therefore, it can be inferred that the customer does not have any additional questions. Hence, the BA does not need to ask if the customer has additional questions before transferring to an ADP.

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39.

Secure the CallThe BA put plans in the cart for the customer and transferred to an ADP to complete the applications. The ADP secured the customer's record and completed his applications. Did the ADP need to secure the customer's account?
- Yes
- No
Correct Answer

A. No

Explanation

The ADP did not need to secure the customer's account because the question states that the ADP "secured the customer's record," indicating that the customer's information was already protected. Additionally, the ADP completed the customer's applications, suggesting that they had access to the necessary information without needing to secure the account further.

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40.

Disclaimer, Disclaimer ScriptingThe HIPAA can listen to the disclaimer without the customer on the line as long as the customer is back to give their voice signature.
- True
- False
Correct Answer

A. False

Explanation

The given statement is false. According to HIPAA regulations, the customer must be on the line and give their voice signature for the disclaimer to be recorded. The HIPAA cannot listen to the disclaimer without the customer present.

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41.

Closing Script, Contact InformationIf the BA/ADP skips the entire second paragraph of the closing script for a MAPD, how will QM score the corresponding section?
- Yes
- Minor
- Major
- N/A
Correct Answer

A. Minor

Explanation

If the BA/ADP skips the entire second paragraph of the closing script for a MAPD, the QM score will be considered as "Minor". This means that it is a minor issue or error, but it does not have a significant impact on the overall quality of the script or the communication process.

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42.

Opening ScriptIf the POA started the application (The customer was not on the line during the Opening Script) and the customer completes it by giving their voice signature after the disclaimer, what line items on the QM form should be marked down?
- 3-10 only
- 6-10 only
- 9 only
- 53 only
- We would only coach this
Correct Answer

A. 3-10 only

Explanation

If the POA started the application and the customer completes it by giving their voice signature after the disclaimer, only line items 3-10 on the QM form should be marked down. This means that the customer provided their voice signature and completed the necessary steps from line 3 to line 10. The other options, 6-10 only, 9 only, and 53 only, do not accurately reflect the scenario described. The final option, "We would only coach this," suggests that coaching would be provided in this situation, but it does not specify which line items should be marked down on the QM form.

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43.

BA Prohibited PracticesWhen the customer called, he already knew what plan he wanted. The BA added the plan to the cart and transferred the call to the enrollment team without going over the premium or plan benefits.Would QM score this as a Prohibited Practice because the BA did not go over the benefits or premium?
- Yes
- No
Correct Answer

A. No

Explanation

The question asks whether the Quality Management (QM) would score this situation as a Prohibited Practice because the BA did not go over the benefits or premium. The answer is "No" because the customer already knew what plan he wanted, so there was no need for the BA to go over the benefits or premium. The QM would not consider this as a Prohibited Practice as long as the customer's needs and preferences were already known and met.

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44.

Secure the CallThe HIPAA secures the call. The customer joins the call 30 minutes later. Would the customer need to secure his/her record?
- No. The record was already secured by the HIPAA
- Yes. Even though the HIPAA already secured the record, the customer would also have to secure it if they join the call.
Correct Answer

A. No. The record was already secured by the HIPAA

Explanation

The answer is No because the HIPAA (Health Insurance Portability and Accountability Act) already secures the call. Since the record was already secured by the HIPAA, the customer does not need to secure it again when they join the call. The HIPAA ensures the privacy and security of health information, so once it has been secured, there is no need for additional measures from the customer.

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45.

Disclaimer, Disclaimer ScriptingThe customer is hard of hearing so he told the BA his HIPAA rep could listen to the disclaimer for him. BA said Ok and played the disclaimer for the HIPAA. How should this be scored?
- Yes
- Minor
- Major
- N/A
Correct Answer

A. Major

Explanation

The answer is Major because the Business Analyst (BA) allowed someone who is not authorized to listen to the disclaimer, which is a violation of HIPAA regulations. The HIPAA rep should not have been given access to sensitive information without proper authorization. This is a serious breach of privacy and could result in significant consequences for the company.

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46.

Disclaimer, Disclaimer ScriptingThe customers are both enrolling into MAPD plans. MR is enrolling into the Aetna Medicare Value Plan HMO and MRS is enrolling into the AARP MedicareComplete HMO. The BA/ADP can play one disclaimer after the applications are completed because both plans are MAPDs.
- True
- False
Correct Answer

A. False

Explanation

The BA/ADP cannot play one disclaimer after the applications are completed because both plans are MAPDs.

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47.

Opening ScriptThe HIPAA statement/question (number 10) must be read/asked on every application.
- True
- False
Correct Answer

A. False

Explanation

The statement/question (number 10) does not need to be read/asked on every application according to HIPAA regulations.

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48.

Voice Signature, Confirmation Number The following people can provide the voice signature:(Check all that apply)
- The customer
- HIPAA
- The legal guardian/conservator
- A person that has a Medical Directive for the customer
- A person named in the customer's living will
- A person who holds (the appropriate) Power of Attorney for the customer
Correct Answer(s)

A. The customer
A. The legal guardian/conservator
A. A person who holds (the appropriate) Power of Attorney for the customer

Explanation

The correct answer is that the customer, the legal guardian/conservator, and a person who holds the appropriate Power of Attorney for the customer can provide the voice signature. These individuals have the legal authority to make decisions on behalf of the customer and can therefore provide the necessary confirmation for the voice signature.

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49.

Secure the CallThe customer calls in and asks to speak with a specific BA. The BA transferred the call to the other agent without securing the call. The BA that the customer called to speak with does not need to secure the record.
- True
- False
Correct Answer

A. True

Explanation

The customer called in specifically asking to speak with a specific BA. The BA transferred the call to another agent without securing the call. This implies that the customer's request was not related to any sensitive or confidential information that would require the call to be secured. Therefore, it is true that the BA that the customer called to speak with does not need to secure the record.

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Current Version
Mar 17, 2023

Quiz Edited by
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Aug 21, 2014

Quiz Created by
Bthorup

2014 - Qm - Final 1

BenefitsFill in the Blank:Medigap Plan N-Covers 100% of Part B coinsurance after you meet your yearly Part ____ deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.

Quiz Preview

Medigap, page 2 and beyondIf the ADP has to clarify a question on page 4 for the customer and then does not re-state the question, which carrier would that be acceptable for?

Sales callsAdjusting the words in the MIR is acceptable as long as it does not change the meaning.

BA Prohibited PracticesIf the BA states that the customer's HICN is the same as their social security number with a letter, would this be marked as a Prohibited Practice?

BA Prohibited PracticesThe BA and the customer do not have a good phone connection so the customer asks the BA to email some information on the plan they are discussing. The BA copies the plan information from the Summary of Benefits and sends it to the customer. Is this a Prohibited Practice?

ADP Prohibited PracticesIs the following scenario a Prohibited Practice and if so, which Prohibited Practice would you use:The ADP told the customer that he works for the Centers of Medicare and Medicaid Services.

Closing Script and Contact InformationWhen is it acceptable for the BA/ADP to not read the closing script?

Application, page 1The customer said their date of birth is 5/31/36. The ADP asked the customer to restate the date of birth but give a four digit year. Which statement is most accurate?

BenefitsThe ADP must read additional benefits from the Full Summary of Benefits on a HMO-POS plan. What are those benefits?

BenefitsWhat additional benefits must be read if the customer resides in a nursing home?

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Medicare Annual Enrollment Period is from October 7th to December 15th every year.

Closing Script, Contact Information When providing the customer with our contact information, the customer stated that they do not need the TTY number before the BA could provide it. How would this be graded (provided all other information was given correctly)?

Medigap, page 2 and beyond"Do you intend to replace your current healthcare coverage with this Medicare Supplement policy?"This question is always marked No on each application for every carrier.

Medigap, page 2 and beyondQM will score line item 41 as a Major if the BA skips the following questions on a guaranteed issue application: Current Age, Height, Weight, BMI.

BenefitsIf the ADP read the entire portion from the HMO-POS section, would QM score them down?

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Plan F is the cream of the crop.

Voice Signature, Confirmation NumberWhat are the three parts of the voice signature that the customer must state for it to be valid?Check all that apply.

Closing Script, Contact InformationThe BA/ADP must read the closing script to each customer individually when completing a joint application.

Medigap, page 2 and beyondIf the question regarding how the customer would prefer to pay the premiums is asked twice on a Medigap application, the ADP/BA may skip it the second time it appears.

Medigap, page 2 and beyondIf the ADP does not ask for the AARP membership number on the first page, QM scores Major on number 41 because there is no line item for this question for the AARP membership field.

Sales callsThe customer called and discussed plan options with the BA on Monday. The customer needed more time to decide on a selection and called back on Friday and spoke with the same BA. Would the BA need to read the MIR prior to quoting even if it was read on the initial call?

Sales CallsThe BA read the Medical Information Release after giving two Medigap premiums but did not discuss any plan benefits. Would this be Non-Compliant?

BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"The Plan N has no deductibles"

Red FlagThe customer must be enrolled in a Medical plan through One Exchange to qualify for his funding.The customer tells the BA that he wants the same individual Medicare Advantage plan he currently has, so the BA enrolled him in the exact same plan. Which Red Flag would you use?

Disclaimer, Disclaimer ScriptingIf the call disconnects during the legal disclaimer, is it acceptable for the BA to call the customer back to finish it?

Closing Script, Contact Information Who is eligible to receive the closing script information on their own?(Select all that apply)

Sales CallsIf an LBS is brought on the line by an ADP and the LBS puts a new plan in the cart, does the LBS have to read the intent to enroll scripting before dropping off the call?

Opening Script How would you grade the following statement and why?"My name is Fi Schneider, today is Friday July 11th. This call will be recorded. Do I have your permission to record this conversation to confirm your enrollment?"

Sales CallsWhich version of the MIR would not cause the call to be Non-Compliant?The correct statement reads:'As we proceed, you are not required to answer any health or prescription related questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?'

ADP Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"Humana is a better company than Health Net. You should have chosen Humana."

Application, page 1The customer's name is William George Johnson. On the application, he stated his first name as 'George' and on the application it appears as 'William'. What will QM do for number 28?

Secure the CallDuring the sales portion of the call, the line disconnects. The customer calls back within 2 minutes and is routed to the same BA.The BA does not have to secure the call if the customer calls right back and is routed to the same BA.

BenefitsADP/BA is completing a Medigap Plan N. What benefits are they required to read?

BenefitsBA's are allowed to skip benefits for a Plan F, but ADPs are not.

Opening ScriptThe BA/ADP asks for permission to record the conversation on a joint application- Mr. Wayne says "Yes you do.", however Mrs. Wayne says nothing. How should this be graded?

Sales CallsThe customer told the BA they were very helpful and answered all of their questions. Would the BA still need to ask if the customer had additional questions prior to transferring to an ADP?

Secure the CallThe BA put plans in the cart for the customer and transferred to an ADP to complete the applications. The ADP secured the customer's record and completed his applications. Did the ADP need to secure the customer's account?

Disclaimer, Disclaimer ScriptingThe HIPAA can listen to the disclaimer without the customer on the line as long as the customer is back to give their voice signature.

Closing Script, Contact InformationIf the BA/ADP skips the entire second paragraph of the closing script for a MAPD, how will QM score the corresponding section?

Opening ScriptIf the POA started the application (The customer was not on the line during the Opening Script) and the customer completes it by giving their voice signature after the disclaimer, what line items on the QM form should be marked down?

Secure the CallThe HIPAA secures the call. The customer joins the call 30 minutes later. Would the customer need to secure his/her record?

Disclaimer, Disclaimer ScriptingThe customer is hard of hearing so he told the BA his HIPAA rep could listen to the disclaimer for him. BA said Ok and played the disclaimer for the HIPAA. How should this be scored?

Disclaimer, Disclaimer ScriptingThe customers are both enrolling into MAPD plans. MR is enrolling into the Aetna Medicare Value Plan HMO and MRS is enrolling into the AARP MedicareComplete HMO. The BA/ADP can play one disclaimer after the applications are completed because both plans are MAPDs.

Opening ScriptThe HIPAA statement/question (number 10) must be read/asked on every application.

Voice Signature, Confirmation Number The following people can provide the voice signature:(Check all that apply)

Secure the CallThe customer calls in and asks to speak with a specific BA. The BA transferred the call to the other agent without securing the call. The BA that the customer called to speak with does not need to secure the record.