CMS
TEST
Compre
hensive
Questio
ns with
Verified
Answers
Graded
A+
1. My doctor says
he filed a claim
and You did not
pay. I want him
paid,
who do I need to
talk to? Answer: This is an Claims
appeal. The rep should recognize this is
an appeal
and otter to start the appeal
process for them and ask for
basic questions. Info asked
,should include provider info.
***************
****** Located?
Medicare Ops
Portal/ WP -CG&A
& Billing
2. I need to get a
Pap test, can I go
to my
gynecologist to
do
this? Answer: Yes, they can, no PA
required. Is your Gynecologist in
network?
Yes , no need for referral
***************
****** Located?
WORKBOOK & EOC - Chapter 3 Sec2.2
3. I want to get
a flu shot,
where can I go
to get it and
what will it cost
me? Answer: They can go to
the PCP, their pharmacy or
any in network pharmacy and
cost will be zero. It
is part b coverage, no cost
,associated to it, zero cost.
***************
****** Located?
SOB & EOC -
Chapter 4
4. I need to get
a Hepatitis B
shot, where can
I go and how
much will it
cost me? Answer: They can go to the
PCP, their pharmacy or any in network
pharmacy and cost will be
zero. It is part b coverage,
no cost associated to it, zero
cost
***************
****** Located?
SOB & EOC -
Chapter 4
5. I received a
letter telling me
it is time for a
mammogram,
what is that,
how do I get
one, and how
much will it
cost. Answer: Breast
cancer screening
(mammograms) Covered
services include Answer: One
, baseline mammogram
between the ages of 35 and 39
One screening mammogram
every 12 months for women
age. Go to imiging center, PCP.
There is no coinsurance,
TEST
Compre
hensive
Questio
ns with
Verified
Answers
Graded
A+
1. My doctor says
he filed a claim
and You did not
pay. I want him
paid,
who do I need to
talk to? Answer: This is an Claims
appeal. The rep should recognize this is
an appeal
and otter to start the appeal
process for them and ask for
basic questions. Info asked
,should include provider info.
***************
****** Located?
Medicare Ops
Portal/ WP -CG&A
& Billing
2. I need to get a
Pap test, can I go
to my
gynecologist to
do
this? Answer: Yes, they can, no PA
required. Is your Gynecologist in
network?
Yes , no need for referral
***************
****** Located?
WORKBOOK & EOC - Chapter 3 Sec2.2
3. I want to get
a flu shot,
where can I go
to get it and
what will it cost
me? Answer: They can go to
the PCP, their pharmacy or
any in network pharmacy and
cost will be zero. It
is part b coverage, no cost
,associated to it, zero cost.
***************
****** Located?
SOB & EOC -
Chapter 4
4. I need to get
a Hepatitis B
shot, where can
I go and how
much will it
cost me? Answer: They can go to the
PCP, their pharmacy or any in network
pharmacy and cost will be
zero. It is part b coverage,
no cost associated to it, zero
cost
***************
****** Located?
SOB & EOC -
Chapter 4
5. I received a
letter telling me
it is time for a
mammogram,
what is that,
how do I get
one, and how
much will it
cost. Answer: Breast
cancer screening
(mammograms) Covered
services include Answer: One
, baseline mammogram
between the ages of 35 and 39
One screening mammogram
every 12 months for women
age. Go to imiging center, PCP.
There is no coinsurance,
