Medicare Compliance Training Exam Questions
with Correct Answers (VerifiedAnswers) Plus
Rationales 2026 Q&A Instant Download PDF
Question 1
What is the primary purpose of an effective Medicare
compliance program?
A. To increase the organization's revenue
B. To eliminate all employee disciplinary actions
C. To prevent, detect, and correct Medicare non-compliance
and FWA
D. To replace all internal audit activities
Correct Answer: C. To prevent, detect, and correct Medicare
non-compliance and FWA
An effective compliance program is designed to prevent, detect,
and correct non-compliance and fraud, waste, and abuse. CMS
emphasizes that an effective program should be tailored to the
organization's operations, adequately resourced, promote
standards of conduct, and establish clear communication
channels for reporting concerns. Compliance is therefore a
,continuous organizational responsibility rather than simply a
training exercise.
Question 2
Which Medicare program provides coverage primarily for
inpatient hospital services?
A. Part B
B. Part C
C. Part D
D. Part A
Correct Answer: D. Part A
Medicare Part A is commonly referred to as Hospital Insurance.
It helps cover inpatient hospital care, qualifying skilled nursing
facility care, hospice care, and certain home health services.
Understanding the distinction among Medicare Parts is
fundamental because compliance requirements and billing
responsibilities can vary according to the benefit involved.
Question 3
What does Medicare Part B primarily cover?
A. Prescription drugs only
B. Physicians' services and outpatient medical services
,C. Inpatient hospital services only
D. Medicare Advantage supplemental benefits only
Correct Answer: B. Physicians' services and outpatient medical
services
Part B is Medicare Medical Insurance and generally covers
medically necessary physicians' services, outpatient care,
certain preventive services, laboratory and diagnostic services,
durable medical equipment, and other covered medical services.
Compliance personnel should understand Part B because
inaccurate documentation, coding, billing, or medical-necessity
determinations can create significant compliance risks.
Question 4
What is Medicare Part C?
A. Medicare Supplement Insurance
B. Medicare Advantage
C. Medicare prescription drug coverage only
D. Medicaid
Correct Answer: B. Medicare Advantage
Medicare Part C refers to Medicare Advantage plans offered by
private organizations approved by Medicare. Medicare
Advantage plans generally provide Medicare Part A and Part B
benefits, except hospice care, and may offer additional benefits.
, Organizations participating in Part C must satisfy applicable
CMS requirements, including compliance-program
requirements.
Question 5
What is the primary purpose of Medicare Part D?
A. Hospital insurance
B. Physician insurance
C. Prescription drug coverage
D. Long-term custodial care
Correct Answer: C. Prescription drug coverage
Part D provides Medicare prescription drug coverage through
Medicare-approved plans. Because Part D involves prescription
benefits, formulary administration, claims, coverage
determinations, and related activities, organizations operating
in this area must maintain strong compliance controls and
address potential fraud, waste, and abuse.
Question 6
Which of the following is one of CMS's seven core compliance-
program requirements for Medicare Part C and Part D
sponsors?
with Correct Answers (VerifiedAnswers) Plus
Rationales 2026 Q&A Instant Download PDF
Question 1
What is the primary purpose of an effective Medicare
compliance program?
A. To increase the organization's revenue
B. To eliminate all employee disciplinary actions
C. To prevent, detect, and correct Medicare non-compliance
and FWA
D. To replace all internal audit activities
Correct Answer: C. To prevent, detect, and correct Medicare
non-compliance and FWA
An effective compliance program is designed to prevent, detect,
and correct non-compliance and fraud, waste, and abuse. CMS
emphasizes that an effective program should be tailored to the
organization's operations, adequately resourced, promote
standards of conduct, and establish clear communication
channels for reporting concerns. Compliance is therefore a
,continuous organizational responsibility rather than simply a
training exercise.
Question 2
Which Medicare program provides coverage primarily for
inpatient hospital services?
A. Part B
B. Part C
C. Part D
D. Part A
Correct Answer: D. Part A
Medicare Part A is commonly referred to as Hospital Insurance.
It helps cover inpatient hospital care, qualifying skilled nursing
facility care, hospice care, and certain home health services.
Understanding the distinction among Medicare Parts is
fundamental because compliance requirements and billing
responsibilities can vary according to the benefit involved.
Question 3
What does Medicare Part B primarily cover?
A. Prescription drugs only
B. Physicians' services and outpatient medical services
,C. Inpatient hospital services only
D. Medicare Advantage supplemental benefits only
Correct Answer: B. Physicians' services and outpatient medical
services
Part B is Medicare Medical Insurance and generally covers
medically necessary physicians' services, outpatient care,
certain preventive services, laboratory and diagnostic services,
durable medical equipment, and other covered medical services.
Compliance personnel should understand Part B because
inaccurate documentation, coding, billing, or medical-necessity
determinations can create significant compliance risks.
Question 4
What is Medicare Part C?
A. Medicare Supplement Insurance
B. Medicare Advantage
C. Medicare prescription drug coverage only
D. Medicaid
Correct Answer: B. Medicare Advantage
Medicare Part C refers to Medicare Advantage plans offered by
private organizations approved by Medicare. Medicare
Advantage plans generally provide Medicare Part A and Part B
benefits, except hospice care, and may offer additional benefits.
, Organizations participating in Part C must satisfy applicable
CMS requirements, including compliance-program
requirements.
Question 5
What is the primary purpose of Medicare Part D?
A. Hospital insurance
B. Physician insurance
C. Prescription drug coverage
D. Long-term custodial care
Correct Answer: C. Prescription drug coverage
Part D provides Medicare prescription drug coverage through
Medicare-approved plans. Because Part D involves prescription
benefits, formulary administration, claims, coverage
determinations, and related activities, organizations operating
in this area must maintain strong compliance controls and
address potential fraud, waste, and abuse.
Question 6
Which of the following is one of CMS's seven core compliance-
program requirements for Medicare Part C and Part D
sponsors?
