Post Test - Appeals

15 Questions | Total Attempts: 57

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Post Test - Appeals - Quiz

This is an open book test.


Questions and Answers
  • 1. 
    If an initial determination is a denial, appeal rights are given in the denial notice.
    • A. 

      True

    • B. 

      False

  • 2. 
    For Part C organization determination, the plan may request a 14 calendar-day extension if it is in the best interest of the member.
    • A. 

      True

    • B. 

      False

  • 3. 
    A _____________  must be sent and member must be given expedited grievance rights.
    • A. 

      Blank form

    • B. 

      Written notice

    • C. 

      Copy of front sheet

  • 4. 
    Members cannot request an expedited grievance if they disagree with the 14-day extension.
    • A. 

      True

    • B. 

      False

  • 5. 
    What does the acronym NDMC mean?
    • A. 

      I don't know

    • B. 

      Not Denied Medical Coverage

    • C. 

      Notice of Denial of Medical Coverage

  • 6. 
    CMS requirements state that written notices must include:
    • A. 

      Appeal rights and with NDMC's both expedited and standard appeal rights

    • B. 

      Written notices must describe the member's right to present evidence in writing

    • C. 

      Written notices must describe the member's right to present evidence in person

    • D. 

      All of the above

  • 7. 
    CMS requirements state that a plan must automatically handle an expedited request if the MD indicates that applying standard timeframe would jeopardize the member's health.
    • A. 

      True

    • B. 

      False

  • 8. 
    On appeals process- 1st level -the member may file an appeal within how many days?
    • A. 

      5 days

    • B. 

      60 days

    • C. 

      365 days

  • 9. 
    What does the acronym IRE mean? 
    • A. 

      Invisible Raised Eyebrow

    • B. 

      Independent Review Entity

    • C. 

      Individual Request Express

  • 10. 
    Termination of inpatient hospital services (IMs) must be delivered in person to member if member does not have an appointed representative.
    • A. 

      True

    • B. 

      False

  • 11. 
    What does the acronym NOMNC mean? 
    • A. 

      Notice of Medicare Non-Coverage

    • B. 

      Notice of Medicaid Coverage

    • C. 

      None of the above

  • 12. 
    When terminating SNF, Home Health, and CORF services, the provider must issue NOMNC within 2 calendar days of termination of services.
    • A. 

      True

    • B. 

      False

  • 13. 
    A NOMNC is not to be issued when the Medicare benefit is exhausted. A NDMC must be issued instead.
    • A. 

      True

    • B. 

      False

  • 14. 
    On the termination of SNF, Home Health, and CORF services the follwing are true:
    • A. 

      Member may request a fast track appeal by telephone or in writing to the QIO

    • B. 

      Request must be made by no later than noon of the day after the receipt of the NOMNC

    • C. 

      All of the above

  • 15. 
    If the plan upholds or agrees with the denial decision,  the member is liable for services from the date of determination of services.
    • A. 

      True

    • B. 

      False

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