2014 - Qm - Final 1

67 Questions | By Bthorup | Updated: Mar 17, 2022 | Attempts: 159

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Final Exam 1

Questions and Answers

1.

Disclaimer, Disclaimer ScriptingThe customer/POA is not on the line to hear the scripting that is read prior to the disclaimer. How will QM score number 51?
- A.
  
  Yes
- B.
  
  Minor
- C.
  
  Major
- D.
  
  N/A
2.

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.
- A.
  
  True
- B.
  
  False
3.

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.
- A.
  
  True
- B.
  
  False
4.

Disclaimer, Disclaimer ScriptingIf the call disconnects during the legal disclaimer, is it acceptable for the BA to call the customer back to finish it?
- A.
  
  Yes
- B.
  
  No
5.

Closing Script, Contact InformationThe BA/ADP must read the closing script to each customer individually when completing a joint application.
- A.
  
  True
- B.
  
  False
6.

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)?
- A.
  
  Yes
- B.
  
  Minor
- C.
  
  Major
- D.
  
  N/A
7.

Closing Script, Contact Information Who is eligible to receive the closing script information on their own?(Select all that apply)
- A.
  
  Authorized representative
- B.
  
  HIPAA
- C.
  
  POA
- D.
  
  Customer
8.

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?
- A.
  
  Yes
- B.
  
  Minor
- C.
  
  Major
- D.
  
  N/A
9.

Closing Script and Contact InformationWhen is it acceptable for the BA/ADP to not read the closing script?
- A.
  
  Never
- B.
  
  After completing a Medigap application IF they will also be completing a PDP application and reading the closing script after the PDP
- C.
  
  If it is the end of their shift and they want to go home
- D.
  
  The closing script is not required
10.

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?
- A.
  
  Minor because it was done but not done correctly
- B.
  
  Check with a supervisor before scoring it down
- C.
  
  Yes, because George is his middle name
- D.
  
  Major because the application doesn't match what was heard on the recording
11.

Application, page 1The BA/ADP is able to answer which question(s) for the customer on page 1?Check all that apply.
- A.
  
  Alternate mailing address
- B.
  
  Gender
- C.
  
  Desired Effective Date
- D.
  
  Medicare Claim Number
- E.
  
  Alternate Contact
- F.
  
  POA question
12.

Application, page 1What question(s) on page 1 can an ADP/BA skip and not get marked down? Check all that apply.
- A.
  
  Middle Name
- B.
  
  Primary Phone Number
- C.
  
  Alternate Phone Number
- D.
  
  Title
- E.
  
  Gender
- F.
  
  HICN
- G.
  
  Alternate Address
- H.
  
  Alternate Contact
- I.
  
  Name on the Medicare card
- J.
  
  Desired Effective Date
- K.
  
  Email address
13.

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?
- A.
  
  The ADP knows they will lose points if they do not ask for the four digit year
- B.
  
  The ADP will not lose points if they do not ask for the four digit year
- C.
  
  The ADP is trying to get extra points on their QM form
14.

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.
- A.
  
  True
- B.
  
  False
15.

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.
- A.
  
  True
- B.
  
  False
16.

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.
- A.
  
  True
- B.
  
  False
17.

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.
- A.
  
  True
- B.
  
  False
18.

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?
- A.
  
  Blue Shield of Maryland
- B.
  
  Aetna
- C.
  
  BCBS of KY
- D.
  
  Humana
- E.
  
  Carefirst BlueCross BlueShield of Maryland
19.

BenefitsADP/BA is completing a Medigap Plan N. What benefits are they required to read?
- A.
  
  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.”
- B.
  
  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.
- C.
  
  Part B Excess
- D.
  
  All of the Above
- E.
  
  None of the Above-Benefits are not required to be read on any Medigap plans
20.

BenefitsCustomer is enrolling into a High Deductible Plan F. Which benefits are required to be read to the Customer?
- A.
  
  None. The benefits are not required for the Plan F
- B.
  
  Doctor and Hospital Choice
- C.
  
  Deductible for Medical Only
- D.
  
  Doctor Office Visit
21.

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.
  
  A
- B.
  
  B
- C.
  
  C
- D.
  
  D
22.

BenefitsBA's are allowed to skip benefits for a Plan F, but ADPs are not.
- A.
  
  True
- B.
  
  False
23.

BenefitsThe ADP must read additional benefits from the Full Summary of Benefits on a HMO-POS plan. What are those benefits?
- A.
  
  Chiropractic Services
- B.
  
  Inpatient Hospital Care/Hospital Stays
- C.
  
  Ambulatory Surgical Center
- D.
  
  Primary Care Physician
- E.
  
  Physical Therapy
- F.
  
  Physician Specialist Services
- G.
  
  Diagnostic Radiological Services
- H.
  
  Ambulance Services
24.

BenefitsIf the ADP read the entire portion from the HMO-POS section, would QM score them down?
- A.
  
  No. The ADP went above and beyond what they had to read and should not be marked down.
- B.
  
  Yes. The ADP only has to read four benefits as listed in the definitions
- C.
  
  No. As long as long as they read them all accurately.
25.

BenefitsOut of the 16 line items in the Benefits section, how many can be scored as a Major?
- A.
  
  None
- B.
  
  One
- C.
  
  Three
- D.
  
  Sixteen