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. Under the Medicare Shared Savings Program, which track allows ACOs to share in savings without taking on downside financial risk?

    Answer: BASIC track Level A or B

    BASIC track Levels A and B are one-sided risk tracks where ACOs can share in savings without being exposed to losses.

  2. A Medicare beneficiary's oncologist recommends a new cancer drug. The drug is on the formulary but requires step therapy. What does step therapy require?

    Answer: The patient must first try a preferred lower-cost drug before the plan approves the requested drug

    Step therapy requires trying specified alternative treatments first before a plan will cover the originally requested medication.

  3. Which Medicare benefit covers medically necessary durable medical equipment (DME) such as wheelchairs and hospital beds for use in the home?

    Answer: Medicare Part B

    Durable medical equipment prescribed for home use is covered under Medicare Part B at 80% of the approved amount after the deductible.

  4. A beneficiary with end-stage renal disease (ESRD) wants to enroll in a Medicare Advantage plan. When may an ESRD patient enroll in a Medicare Advantage plan?

    Answer: At any time since the 21st Century Cures Act removed the ESRD enrollment restriction

    The 21st Century Cures Act, effective January 1, 2021, removed the prohibition on ESRD patients enrolling in Medicare Advantage plans.

  5. A patient needs a second opinion before major surgery. How does Medicare Part B handle second surgical opinion consultations?

    Answer: Medicare Part B covers second opinions at the same 80/20 cost-sharing as other physician services

    Medicare Part B covers second and even third surgical opinions at the standard 80% coinsurance rate after the deductible.

  6. A CMS specialist is assisting a beneficiary who requires both Medicare and Medicaid (dual eligible). Which program coordinates benefits to minimize cost-sharing for dual eligibles?

    Answer: Medicare-Medicaid Plan (MMP) or D-SNP

    Medicare-Medicaid Plans (MMPs) and Dual Eligible Special Needs Plans (D-SNPs) integrate Medicare and Medicaid benefits to reduce cost-sharing and improve care coordination for dual eligibles.

  7. A beneficiary's Medicare Advantage plan denies a requested inpatient stay as not medically necessary. What is the beneficiary's first recourse?

    Answer: Request a redetermination (Level 1 Appeal) from the plan

    The first step in Medicare's appeals process for a Medicare Advantage denial is a redetermination request filed with the plan (Level 1).