CMS Emergency Procedures & Response 3

Question 1

A CMS specialist is advising a dual-eligible beneficiary (Medicare and Medicaid) who needs emergency mental health services. Which program is the primary payer?

Accepted Answer

Medicare is the primary payer and Medicaid pays secondary costs Medicare does not cover

Answer

For dual-eligible beneficiaries, Medicare always pays first as the primary payer, and Medicaid covers remaining costs up to its limits.

Question 2

During a public health emergency declared by HHS, CMS may issue 1135 waivers. What is the primary purpose of these waivers?

Accepted Answer

To temporarily waive or modify certain Medicare and Medicaid requirements to maintain access to care

Answer

Section 1135 waivers temporarily waive or modify certain federal healthcare requirements so providers can continue serving beneficiaries during emergencies.

Question 3

A Medicare beneficiary enrolled in a PACE program has a medical emergency. Who is responsible for coordinating their emergency care?

Accepted Answer

The PACE interdisciplinary team, which retains responsibility for all care coordination

Answer

PACE organizations retain full responsibility for all care coordination, including emergency services, as part of their capitated care model.

Question 4

When a Medicare beneficiary in a skilled nursing facility (SNF) develops a sudden severe condition, under what circumstance would Part A NOT cover their emergency hospital transfer?

Accepted Answer

If the beneficiary has exhausted their SNF benefit days and their 60-day benefit period has not reset

Answer

If a beneficiary has exhausted their 100 SNF benefit days and has not re-qualified through a new qualifying hospital stay, Part A will not cover additional inpatient care.

Question 5

A Medicare beneficiary calls after receiving an Advance Beneficiary Notice (ABN) before a procedure. The beneficiary signed the ABN but now argues the procedure was actually an emergency. What is the ABN's significance in this case?

Accepted Answer

An ABN cannot be issued for emergency services; if issued, it is invalid and Medicare must pay

Answer

ABNs are not valid for emergency or urgently needed services; issuing one for a true emergency does not shift financial liability to the beneficiary.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Emergency Procedures & Response 3