AHIP FWA 2023 QUESTIONS AND
ANSWERS
1. A man or woman drops off a prescription for a beneficiary who is a "normal" patron. The
prescription is for a controlled substance with a quantity of one hundred sixty. This
beneficiary generally gets a amount of 60, no longer a hundred and sixty. You evaluation
the prescription and have issues about viable forgery. What is your next step? -
ANSWER-Call the prescriber to affirm the quantity
2. A sales agent, employed by means of the Sponsor's first-tier, downstream, or associated
entity (FDR), submitted an application for processing and asked two things: 1) to
returned-date the enrollment date by one month, and a pair of) to waive all monthly rates
for the beneficiary. What ought to you do? - ANSWER-Process the application well
(without the asked revisions)—tell your supervisor and the compliance officer
approximately the sales agent's request
3. Abuse involves charge for gadgets or offerings whilst there is no felony entitlement to
that price and the provider has no longer knowingly or intentionally misrepresented
statistics to reap fee. - ANSWER-True
4. ACA Section 1557 regulations for disability subject - ANSWER-Policies and
procedures, physical get admission to, and verbal exchange.
5. Agent Harriet Walker has these days begun advertising Medicare Advantage and
associated merchandise geared toward meeting the wishes of senior citizens. Client
Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the start of
September. If you have been in Agent Walker's function, what could you do? -
ANSWER-Inquire whether the consumer qualifies for a special enrollment period,
and if now not, solicit an enrollment utility once the once a year open enrollment
election period begins on October 15th.
6. Alice is a marketing representative employed via a health plan. Betty is a captive agent
of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who
markets to only one plan/sponsor. Denise is an unbiased agent who markets to
extraordinary styles of organizations. Edward is an unbiased agent who markets
simplest to employer and union organizations. CMS marketing consultant reimbursement
guidelines generally follow to: - ANSWER-Betty and Denise, however now not Alice
(the worker) or Carl or Edward (to whom exceptions apply).
7. All plans must cover at the least the usual Part D insurance or its actuarial equivalent.
Which of the following statements first-rate describes some of the prices a beneficiary
could incur for prescribed drugs underneath the standard coverage? -
ANSWER-Standard Part D insurance might require payment of an annual
deductible, and once beyond the catastrophic insurance threshold, the beneficiary
can pay whichever is greater of either the co-pays for commonplace and logo call
tablets or coinsurance of five%.
,8. Anita Magri will flip age 65 in August 2022. Anita intends to enroll in Original Medicare
Part A and Part B. She could additionally like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in
which he's enrolled. It now not handiest provides overseas travel emergency blessings
but additionally covers his Medicare Part B deductible. Anita comes to you for
recommendation. What need to you inform her? - ANSWER-You are sorry to
disappoint Anita however a Medigap Part F plan is no longer to be had to folks
that turn age sixty five after January 1,2020. Anita might rather consider other
Medigap plans that provide overseas travel benefits however do no longer cowl
the Part B deductible.
9. Any man or woman who knowingly submits false claims to the Government is liable for
five instances the Government's damages resulting from the violator plus a penalty. -
ANSWER-False (it is three times)
10.As a result of violations of ACA Section 1557 nondiscrimination policies, - ANSWER-
11.As a result of violations of ACA Section 1557 nondiscrimination rules, - ANSWER-a
fitness plan may revoke an agent or broker's appointment with the health plan.
12.At a minimum, an effective compliance software consists of 4 center requirements. -
ANSWER-False
13.Auxiliary aids and services should be furnished to individuals with disabilities, inclusive of
those affected by vision or listening to impairments, free of charge, and in a timely way.
Auxiliary aids and offerings encompass which of the following:
I. Massive print substances
II. Certified sign language interpreters
III. Braille substances and shows
IV. Screen reader software - ANSWER-I, II, III and IV
14.BestCare Health Plan has received a request from a kingdom insurance department in
reference to the research of numerous advertising representatives certified by means of
the country who sell Medicare Advantage plans. What motion(s) ought to BestCare
absorb response? - ANSWER-Cooperate with the nation and supply requested
records.
15.Bribes or kickbacks of any type for offerings which are paid under a Federal fitness care
application (which includes Medicare) represent fraud via the man or woman making as
well as the man or woman receiving them. - ANSWER-True
16.By contacting plans to be had for your vicinity, you have found out that the plan you
constitute has a notably lower monthly top rate than the others. Furthermore, you notice
that the plan you constitute has a unique advantages bundle. What should you do to
make sure your customers realize about these portions of statistics? - ANSWER-You
may additionally make comparisons among plans if you may aid them via studies
or statistical data and such comparisons are factually based.
17.Compliance is the duty of the Compliance Officer, Compliance Committee, and Upper
Management handiest. - ANSWER-False
18.Correcting non-compliance________ - ANSWER-Protects enrollees, avoids
recurrence of identical non-compliance, and promotes efficiency
, 19.Daniel is a center-profits Medicare beneficiary. He has continual bronchitis, putting him
at intense threat for pneumonia. Otherwise, he has no issues functioning. Which form of
SNP is in all likelihood to be most suitable for him? - ANSWER-C-SNP
20.Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan but accepts the
plan's phrases and conditions for fee. Mary Rodgers sees Dr. Brennan for treatment.
How an awful lot might also Dr. Brennan rate? - ANSWER-Dr. Brennan can fee Mary
Rogers no more than the cost sharing exact within the PFFS plan's phrases and
circumstance of price which may include balance billing up to 15percentof the
Medicare fee.
21.During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
five-megastar rating in customer service and care coordination, and obtained an normal
plan overall performance rating of a four-superstar, which of the subsequent would be
the fine declaration to say to her? - ANSWER-The Medicare Advantage plan acquired
a five-famous person score in customer support and care coordination with an
universal overall performance rating of four-stars.
22.For a fitness plan, what are the possible consequences of violations of ACA Section
1557? - ANSWER-Loss of federal business and compensatory damages.
23.If you are to comply with Medicare's steering concerning instructional events, which of
the following might be applicable sports? - ANSWER-You may also distribute
enterprise playing cards to those who request information on a way to contact you
for similarly information on the plan(s) you constitute.
24.Juan Perez, who is turning age 65 next month, intends to work for several greater years
at Smallcap, Incorporated. Smallcap has a staff of 15 employees and offers
enterprise-subsidized healthcare insurance. Juan is a naturalized citizen and has
contributed to the Medicare machine for over twenty years. Juan asks you if he can be
entitled to Medicare and if he enrolls how as a way to effect his business
enterprise-sponsored healthcare insurance. How could you reply? - ANSWER-Juan is
probable to be eligible for Medicare once he turns age sixty five and if he enrolls
Medicare might come to be the primary payor of his healthcare claims and
Smallcap does no longer must preserve to offer him insurance similar to the ones
beneath age 65 beneath its organisation-backed organization health plan.
25.Madeline Martinez became widowed numerous years ago. Her husband worked for
decades and contributed into the Medicare system. He also left a tremendous property
which provides Madeline with an annual earnings of approximately $one hundred
thirty,000. Madeline, who has only worked element-time for the remaining 3 years, will
quickly flip age 65 and hopes to join Original Medicare. She comes to you for
recommendation. What should you inform her? - ANSWER-You should inform
Madeline that she will be able to join in Medicare Part A without paying
month-to-month charges due to her husband's lengthy work record and
participation in the Medicare device. You must additionally tell Madeline that she
can pay Part B charges at more than the standard lowest charge but less than the
very best charge due her giant earnings.
26.Medicare Parts C and D sponsors aren't required to have a compliance application. -
ANSWER-False
ANSWERS
1. A man or woman drops off a prescription for a beneficiary who is a "normal" patron. The
prescription is for a controlled substance with a quantity of one hundred sixty. This
beneficiary generally gets a amount of 60, no longer a hundred and sixty. You evaluation
the prescription and have issues about viable forgery. What is your next step? -
ANSWER-Call the prescriber to affirm the quantity
2. A sales agent, employed by means of the Sponsor's first-tier, downstream, or associated
entity (FDR), submitted an application for processing and asked two things: 1) to
returned-date the enrollment date by one month, and a pair of) to waive all monthly rates
for the beneficiary. What ought to you do? - ANSWER-Process the application well
(without the asked revisions)—tell your supervisor and the compliance officer
approximately the sales agent's request
3. Abuse involves charge for gadgets or offerings whilst there is no felony entitlement to
that price and the provider has no longer knowingly or intentionally misrepresented
statistics to reap fee. - ANSWER-True
4. ACA Section 1557 regulations for disability subject - ANSWER-Policies and
procedures, physical get admission to, and verbal exchange.
5. Agent Harriet Walker has these days begun advertising Medicare Advantage and
associated merchandise geared toward meeting the wishes of senior citizens. Client
Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the start of
September. If you have been in Agent Walker's function, what could you do? -
ANSWER-Inquire whether the consumer qualifies for a special enrollment period,
and if now not, solicit an enrollment utility once the once a year open enrollment
election period begins on October 15th.
6. Alice is a marketing representative employed via a health plan. Betty is a captive agent
of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who
markets to only one plan/sponsor. Denise is an unbiased agent who markets to
extraordinary styles of organizations. Edward is an unbiased agent who markets
simplest to employer and union organizations. CMS marketing consultant reimbursement
guidelines generally follow to: - ANSWER-Betty and Denise, however now not Alice
(the worker) or Carl or Edward (to whom exceptions apply).
7. All plans must cover at the least the usual Part D insurance or its actuarial equivalent.
Which of the following statements first-rate describes some of the prices a beneficiary
could incur for prescribed drugs underneath the standard coverage? -
ANSWER-Standard Part D insurance might require payment of an annual
deductible, and once beyond the catastrophic insurance threshold, the beneficiary
can pay whichever is greater of either the co-pays for commonplace and logo call
tablets or coinsurance of five%.
,8. Anita Magri will flip age 65 in August 2022. Anita intends to enroll in Original Medicare
Part A and Part B. She could additionally like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in
which he's enrolled. It now not handiest provides overseas travel emergency blessings
but additionally covers his Medicare Part B deductible. Anita comes to you for
recommendation. What need to you inform her? - ANSWER-You are sorry to
disappoint Anita however a Medigap Part F plan is no longer to be had to folks
that turn age sixty five after January 1,2020. Anita might rather consider other
Medigap plans that provide overseas travel benefits however do no longer cowl
the Part B deductible.
9. Any man or woman who knowingly submits false claims to the Government is liable for
five instances the Government's damages resulting from the violator plus a penalty. -
ANSWER-False (it is three times)
10.As a result of violations of ACA Section 1557 nondiscrimination policies, - ANSWER-
11.As a result of violations of ACA Section 1557 nondiscrimination rules, - ANSWER-a
fitness plan may revoke an agent or broker's appointment with the health plan.
12.At a minimum, an effective compliance software consists of 4 center requirements. -
ANSWER-False
13.Auxiliary aids and services should be furnished to individuals with disabilities, inclusive of
those affected by vision or listening to impairments, free of charge, and in a timely way.
Auxiliary aids and offerings encompass which of the following:
I. Massive print substances
II. Certified sign language interpreters
III. Braille substances and shows
IV. Screen reader software - ANSWER-I, II, III and IV
14.BestCare Health Plan has received a request from a kingdom insurance department in
reference to the research of numerous advertising representatives certified by means of
the country who sell Medicare Advantage plans. What motion(s) ought to BestCare
absorb response? - ANSWER-Cooperate with the nation and supply requested
records.
15.Bribes or kickbacks of any type for offerings which are paid under a Federal fitness care
application (which includes Medicare) represent fraud via the man or woman making as
well as the man or woman receiving them. - ANSWER-True
16.By contacting plans to be had for your vicinity, you have found out that the plan you
constitute has a notably lower monthly top rate than the others. Furthermore, you notice
that the plan you constitute has a unique advantages bundle. What should you do to
make sure your customers realize about these portions of statistics? - ANSWER-You
may additionally make comparisons among plans if you may aid them via studies
or statistical data and such comparisons are factually based.
17.Compliance is the duty of the Compliance Officer, Compliance Committee, and Upper
Management handiest. - ANSWER-False
18.Correcting non-compliance________ - ANSWER-Protects enrollees, avoids
recurrence of identical non-compliance, and promotes efficiency
, 19.Daniel is a center-profits Medicare beneficiary. He has continual bronchitis, putting him
at intense threat for pneumonia. Otherwise, he has no issues functioning. Which form of
SNP is in all likelihood to be most suitable for him? - ANSWER-C-SNP
20.Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan but accepts the
plan's phrases and conditions for fee. Mary Rodgers sees Dr. Brennan for treatment.
How an awful lot might also Dr. Brennan rate? - ANSWER-Dr. Brennan can fee Mary
Rogers no more than the cost sharing exact within the PFFS plan's phrases and
circumstance of price which may include balance billing up to 15percentof the
Medicare fee.
21.During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
five-megastar rating in customer service and care coordination, and obtained an normal
plan overall performance rating of a four-superstar, which of the subsequent would be
the fine declaration to say to her? - ANSWER-The Medicare Advantage plan acquired
a five-famous person score in customer support and care coordination with an
universal overall performance rating of four-stars.
22.For a fitness plan, what are the possible consequences of violations of ACA Section
1557? - ANSWER-Loss of federal business and compensatory damages.
23.If you are to comply with Medicare's steering concerning instructional events, which of
the following might be applicable sports? - ANSWER-You may also distribute
enterprise playing cards to those who request information on a way to contact you
for similarly information on the plan(s) you constitute.
24.Juan Perez, who is turning age 65 next month, intends to work for several greater years
at Smallcap, Incorporated. Smallcap has a staff of 15 employees and offers
enterprise-subsidized healthcare insurance. Juan is a naturalized citizen and has
contributed to the Medicare machine for over twenty years. Juan asks you if he can be
entitled to Medicare and if he enrolls how as a way to effect his business
enterprise-sponsored healthcare insurance. How could you reply? - ANSWER-Juan is
probable to be eligible for Medicare once he turns age sixty five and if he enrolls
Medicare might come to be the primary payor of his healthcare claims and
Smallcap does no longer must preserve to offer him insurance similar to the ones
beneath age 65 beneath its organisation-backed organization health plan.
25.Madeline Martinez became widowed numerous years ago. Her husband worked for
decades and contributed into the Medicare system. He also left a tremendous property
which provides Madeline with an annual earnings of approximately $one hundred
thirty,000. Madeline, who has only worked element-time for the remaining 3 years, will
quickly flip age 65 and hopes to join Original Medicare. She comes to you for
recommendation. What should you inform her? - ANSWER-You should inform
Madeline that she will be able to join in Medicare Part A without paying
month-to-month charges due to her husband's lengthy work record and
participation in the Medicare device. You must additionally tell Madeline that she
can pay Part B charges at more than the standard lowest charge but less than the
very best charge due her giant earnings.
26.Medicare Parts C and D sponsors aren't required to have a compliance application. -
ANSWER-False
