Post Test - Appeals
This is an open book test.
- 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
Questions: 25 | Attempts: 165 | Last updated: Mar 17, 2022
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