AHIP

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? Original Medicare covers ambulance services. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A a...

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? Original Medicare covers ambulance services. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A a...

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. ...

Compliance is the responsibility of the compliance officer, compliance committee and upper management only False Ways to report a compliance issue include All of the above What is the policy of non-retaliation Protects employees who, in good faith, report suspected non-compliance These are examples of issues that can be reported to a compliance department :suspected fraud, waste, and abuse; potential health privacy violation and unethical behavior/employee misconduct True Once a correcti...

Medicare plan means A MA plan, MA-PD plan or PDP Subcontractor means **An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as an agent who has a contract with an agency or filed marketing organization that contract with a Medicare plan. FWA Training: A compliance program component **ALL Medicare plans ar...

Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? -ANS- Medicare does not cover acupuncture, or, in general, glasses or dentures. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtainin...

CARLINI has heard that Medicare Rx plans are only offered through private companies under a program known as MA, NOT by the government. He likes Original Medicare and does NOT want to sign up for an MA product, but he also wants Rx coverage. (Medicare Part D Rx coverage, basics, eligibility) - Answer- Mr. Carlini can stay with Original Medicare and ALSO enroll in a Medicare Rx plan through a private company that has contracted with the government to provide only such drug coverage to eligible ...

Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mrs. Pena is 66 years old, has coverage under an employer plan and will retire next year. she heard she must enroll in part B...

Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. How can you explain this to him? Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. They are not required to offer the standard plan. Question text Mr. Torres has a small savings account. He would like to ...

Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? a. Medicare Part B generally provides prescription drug coverage. b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. c. Medicare Part A generally covers medically necessary physi...