Treatment Planning & Management Flashcards
7 cards from real CMS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Treatment Planning & Management flashcards as text
A Medicare beneficiary with chronic kidney disease stage 4 is referred for dialysis planning. Which Medicare benefit covers routine dialysis treatments once ESRD is established?
Answer: Medicare Part A and Part B
Medicare Part A covers inpatient dialysis and Part B covers outpatient dialysis services for ESRD beneficiaries.
When coordinating a treatment plan for a Medicare Advantage enrollee, what must the CMS specialist verify before authorizing a specialist referral?
Answer: The specialist is in-network or prior authorization is obtained
Medicare Advantage plans use network-based care, so the specialist must be in-network or the plan's prior authorization process must be followed.
A physician wants to place a patient in a skilled nursing facility following a 4-day hospital stay. Does Medicare Part A cover this SNF admission?
Answer: Yes, because 4 days meets the 3-day inpatient requirement
Medicare requires at least a 3-day inpatient qualifying hospital stay, so a 4-day stay satisfies this requirement for SNF coverage.
Under Original Medicare, which entity is primarily responsible for managing a beneficiary's overall treatment plan across multiple providers?
Answer: The beneficiary's primary care physician typically coordinates care
Under Original Medicare's fee-for-service model, the primary care physician generally coordinates care without a formal care manager mandate.
A patient recovering from a stroke requires physical, occupational, and speech therapy in an inpatient rehabilitation facility. What Medicare benefit covers IRF stays?
Answer: Medicare Part A inpatient benefit
Inpatient rehabilitation facility stays are covered under Medicare Part A as an inpatient benefit.
A CMS specialist is helping a beneficiary transition from inpatient to home health care. What eligibility criterion must the patient meet for Medicare home health coverage?
Answer: The patient must be homebound and require skilled care
Medicare home health coverage requires the beneficiary to be homebound and need skilled nursing or therapy services ordered by a physician.
Which Medicare program model holds providers jointly accountable for the quality and cost of care for a defined patient population?
Answer: Accountable Care Organization (ACO)
ACOs coordinate care for Medicare patients and share in savings (or losses) based on quality and cost performance.