, Question 1
A patient with end-stage renal disease (ESRD) is enrolled in Medicare
Advantage (MA). Under current CMS rules, which statement best describes the
coordination of their ESRD benefits?
A. MA plans may limit ESRD enrollees to a narrow network, but must
cover the same benefits as Original Medicare.
B. ESRD patients are excluded from MA enrollment and must remain in
Original Medicare.
C. MA plans receive capitated payments adjusted for ESRD risk, and
must provide all Medicare-covered services including dialysis.
D. ESRD patients can enroll in MA only if they also qualify for
Medicaid.
Correct Answer: C - MA plans receive capitated payments
adjusted for ESRD risk, and must provide all Medicare-covered
services including dialysis.
RATIONALE
Since the 21st Century Cures Act, ESRD patients can enroll in MA
plans, which receive risk-adjusted capitation and must cover all
Medicare benefits. Option B is outdated; A and D misstate network
and eligibility rules.
Question 2
A state expands Medicaid under the ACA using the optional expansion. Which
financing structure correctly describes the federal match for the expansion
population compared to the traditional Medicaid population?
A. The federal government matches at the state's FMAP rate, with no
enhanced match.
B. The federal government provides a 90% match for the expansion
population, while the traditional population uses the state's FMAP.
C. The federal government provides a 100% match for all Medicaid
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, populations for the first three years.
D. The federal match is capped per capita for the expansion group, but
open-ended for the traditional group.
Correct Answer: B - The federal government provides a 90%
match for the expansion population, while the traditional
population uses the state's FMAP.
RATIONALE
Under the ACA, the federal government pays 90% of the cost for the
expansion population, while the traditional Medicaid population is
matched at the state's FMAP (which varies but is at least 50%).
Options A, C, and D misstate the matching formula.
Question 3
A hospital is evaluating its Medicare reimbursement under the Inpatient
Prospective Payment System (IPPS). Which factor most directly determines the
base payment rate for a specific MS-DRG?
A. The hospital's geographic location and wage index.
B. The hospital's case mix index (CMI) for all patients.
C. The number of Medicare patients treated in the previous year.
D. The hospital's disproportionate share hospital (DSH) percentage.
Correct Answer: A - The hospital's geographic location and wage
index.
RATIONALE
The IPPS base payment is adjusted by the wage index, which reflects
geographic labor costs. CMI affects the DRG weight, but the base rate
is primarily wage-index adjusted. DSH and volume affect additional
payments, not the base rate.
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, Question 4
Which of the following best illustrates the concept of 'dual eligible'
beneficiaries and their impact on care coordination?
A. Individuals eligible for both Medicare and Medicaid, often leading to
fragmented care and higher costs.
B. Individuals eligible for both Medicare and private insurance, requiring
coordination of benefits.
C. Individuals eligible for both Medicaid and CHIP, creating gaps in
coverage for adults.
D. Individuals eligible for both VA and Medicare, with VA as primary
payor.
Correct Answer: A - Individuals eligible for both Medicare and
Medicaid, often leading to fragmented care and higher costs.
RATIONALE
Dual eligibles qualify for both Medicare and Medicaid, and their
complex needs often result in fragmented care. Options B, C, and D
describe different dual-eligible combinations or misstate the primary
payor.
Question 5
A Medicare beneficiary is admitted to a hospital for a qualifying stay. Which
condition must be met for subsequent skilled nursing facility (SNF) care to be
covered under Medicare Part A?
A. The hospital stay must be at least 3 consecutive days as an inpatient.
B. The hospital stay must be at least 2 midnights as an inpatient.
C. The SNF admission must occur within 14 days of discharge.
D. The beneficiary must require skilled nursing care daily.
Correct Answer: A - The hospital stay must be at least 3
consecutive days as an inpatient.
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A patient with end-stage renal disease (ESRD) is enrolled in Medicare
Advantage (MA). Under current CMS rules, which statement best describes the
coordination of their ESRD benefits?
A. MA plans may limit ESRD enrollees to a narrow network, but must
cover the same benefits as Original Medicare.
B. ESRD patients are excluded from MA enrollment and must remain in
Original Medicare.
C. MA plans receive capitated payments adjusted for ESRD risk, and
must provide all Medicare-covered services including dialysis.
D. ESRD patients can enroll in MA only if they also qualify for
Medicaid.
Correct Answer: C - MA plans receive capitated payments
adjusted for ESRD risk, and must provide all Medicare-covered
services including dialysis.
RATIONALE
Since the 21st Century Cures Act, ESRD patients can enroll in MA
plans, which receive risk-adjusted capitation and must cover all
Medicare benefits. Option B is outdated; A and D misstate network
and eligibility rules.
Question 2
A state expands Medicaid under the ACA using the optional expansion. Which
financing structure correctly describes the federal match for the expansion
population compared to the traditional Medicaid population?
A. The federal government matches at the state's FMAP rate, with no
enhanced match.
B. The federal government provides a 90% match for the expansion
population, while the traditional population uses the state's FMAP.
C. The federal government provides a 100% match for all Medicaid
Page 2
, populations for the first three years.
D. The federal match is capped per capita for the expansion group, but
open-ended for the traditional group.
Correct Answer: B - The federal government provides a 90%
match for the expansion population, while the traditional
population uses the state's FMAP.
RATIONALE
Under the ACA, the federal government pays 90% of the cost for the
expansion population, while the traditional Medicaid population is
matched at the state's FMAP (which varies but is at least 50%).
Options A, C, and D misstate the matching formula.
Question 3
A hospital is evaluating its Medicare reimbursement under the Inpatient
Prospective Payment System (IPPS). Which factor most directly determines the
base payment rate for a specific MS-DRG?
A. The hospital's geographic location and wage index.
B. The hospital's case mix index (CMI) for all patients.
C. The number of Medicare patients treated in the previous year.
D. The hospital's disproportionate share hospital (DSH) percentage.
Correct Answer: A - The hospital's geographic location and wage
index.
RATIONALE
The IPPS base payment is adjusted by the wage index, which reflects
geographic labor costs. CMI affects the DRG weight, but the base rate
is primarily wage-index adjusted. DSH and volume affect additional
payments, not the base rate.
Page 3
, Question 4
Which of the following best illustrates the concept of 'dual eligible'
beneficiaries and their impact on care coordination?
A. Individuals eligible for both Medicare and Medicaid, often leading to
fragmented care and higher costs.
B. Individuals eligible for both Medicare and private insurance, requiring
coordination of benefits.
C. Individuals eligible for both Medicaid and CHIP, creating gaps in
coverage for adults.
D. Individuals eligible for both VA and Medicare, with VA as primary
payor.
Correct Answer: A - Individuals eligible for both Medicare and
Medicaid, often leading to fragmented care and higher costs.
RATIONALE
Dual eligibles qualify for both Medicare and Medicaid, and their
complex needs often result in fragmented care. Options B, C, and D
describe different dual-eligible combinations or misstate the primary
payor.
Question 5
A Medicare beneficiary is admitted to a hospital for a qualifying stay. Which
condition must be met for subsequent skilled nursing facility (SNF) care to be
covered under Medicare Part A?
A. The hospital stay must be at least 3 consecutive days as an inpatient.
B. The hospital stay must be at least 2 midnights as an inpatient.
C. The SNF admission must occur within 14 days of discharge.
D. The beneficiary must require skilled nursing care daily.
Correct Answer: A - The hospital stay must be at least 3
consecutive days as an inpatient.
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