Practice Test Geeks(CMS) Certified Medicare Specialist Practice Test
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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

  1. A Medicare beneficiary is diagnosed with a terminal illness with a prognosis of 6 months or less. Which Medicare benefit provides comprehensive end-of-life care including pain management and counseling?

    Answer: Medicare hospice benefit

    The Medicare hospice benefit covers comprehensive comfort-focused care for terminally ill beneficiaries who forgo curative treatment.

  2. A patient on Medicare has been approved for hospice care. Which of the following services would NOT be covered under the hospice benefit for the terminal diagnosis?

    Answer: Curative chemotherapy for the terminal illness

    Curative treatment for the terminal diagnosis is not covered under the hospice benefit; beneficiaries must forgo curative care for the terminal condition.

  3. What is the maximum number of days Medicare covers in an SNF at full benefit (no copayment) during a benefit period?

    Answer: 20 days

    Medicare covers days 1–20 in an SNF with no coinsurance; days 21–100 require a daily coinsurance amount.

  4. A Medicare beneficiary needs an MRI to plan cancer treatment. The ordering physician did not obtain prior authorization from the Medicare Advantage plan. What is the most likely outcome?

    Answer: The claim may be denied and the beneficiary could be liable for the cost

    Without required prior authorization, a Medicare Advantage plan can deny payment, potentially leaving the beneficiary responsible for the cost.

  5. Which type of Medicare-covered therapy focuses on restoring a patient's ability to perform daily activities such as dressing and cooking after a debilitating illness?

    Answer: Occupational therapy

    Occupational therapy helps patients regain skills needed for activities of daily living and is covered under Medicare Part B.

  6. A CMS specialist is reviewing a care plan for a beneficiary with diabetes who also has depression. Under the Chronic Care Management (CCM) code structure, what is the minimum monthly time requirement for the basic CCM billing code (99490)?

    Answer: 20 minutes

    CPT 99490 requires at least 20 minutes of clinical staff time per calendar month for chronic care management services.

  7. A beneficiary enrolled in Original Medicare undergoes surgery and requires post-acute care coordination. Which resource helps ensure smooth transitions and reduce readmissions?

    Answer: Transitional Care Management (TCM) services

    Transitional Care Management services (TCM) are billed under Medicare Part B to support patients transitioning from inpatient settings back to community care.