CQM C FINAL PAPER EXAMPREP COMPLETE
QUESTIONS AND ANSWERS VIEW AHEAD
STUDY SHEET
◉ You discover an unattended email address or fax machine in your
office receiving beneficiary appeals requests. You suspect no one is
processing the appeals. What should you do? Answer: Contact your
compliance department.
◉ A sales agent, employed by the Sponsor's first-tier, downstream, or
related entity (FDR), submitted an application for processing and
requested two things: 1) to back-date the enrollment date by one
month, and 2) to waive all monthly premiums for the beneficiary.
What should you do? Answer: Process the application properly
(without the requested revisions)- inform your supervisor and the
compliance officer about the sales agent's request.
◉ You work for a Sponsor. Last month, while reviewing a CMS
monthly report, you identified multiple individuals not enrolled in the
plan but for whom the Sponsor is paid. You spoke to your supervisor
who said don't worry about it. This month, you identify the same
enrollees on the report again. What should you do? Answer: Although
you know about the Sponsor's non-retaliation policy, you are still
nervous about reporting- to be safe, you submit a report through your
compliance department's anonymous tip line to avoid identification.
QUESTIONS AND ANSWERS VIEW AHEAD
STUDY SHEET
◉ You discover an unattended email address or fax machine in your
office receiving beneficiary appeals requests. You suspect no one is
processing the appeals. What should you do? Answer: Contact your
compliance department.
◉ A sales agent, employed by the Sponsor's first-tier, downstream, or
related entity (FDR), submitted an application for processing and
requested two things: 1) to back-date the enrollment date by one
month, and 2) to waive all monthly premiums for the beneficiary.
What should you do? Answer: Process the application properly
(without the requested revisions)- inform your supervisor and the
compliance officer about the sales agent's request.
◉ You work for a Sponsor. Last month, while reviewing a CMS
monthly report, you identified multiple individuals not enrolled in the
plan but for whom the Sponsor is paid. You spoke to your supervisor
who said don't worry about it. This month, you identify the same
enrollees on the report again. What should you do? Answer: Although
you know about the Sponsor's non-retaliation policy, you are still
nervous about reporting- to be safe, you submit a report through your
compliance department's anonymous tip line to avoid identification.
