CMS Treatment Planning & Management 2

Question 1

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?

Accepted Answer

Medicare Part A and Part B

Answer

Medicare Part A covers inpatient dialysis and Part B covers outpatient dialysis services for ESRD beneficiaries.

Question 2

When coordinating a treatment plan for a Medicare Advantage enrollee, what must the CMS specialist verify before authorizing a specialist referral?

Accepted Answer

The specialist is in-network or prior authorization is obtained

Answer

Medicare Advantage plans use network-based care, so the specialist must be in-network or the plan's prior authorization process must be followed.

Question 3

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?

Accepted Answer

Yes, because 4 days meets the 3-day inpatient requirement

Answer

Medicare requires at least a 3-day inpatient qualifying hospital stay, so a 4-day stay satisfies this requirement for SNF coverage.

Question 4

Under Original Medicare, which entity is primarily responsible for managing a beneficiary's overall treatment plan across multiple providers?

Accepted Answer

The beneficiary's primary care physician typically coordinates care

Answer

Under Original Medicare's fee-for-service model, the primary care physician generally coordinates care without a formal care manager mandate.

Question 5

A patient recovering from a stroke requires physical, occupational, and speech therapy in an inpatient rehabilitation facility. What Medicare benefit covers IRF stays?

Accepted Answer

Medicare Part A inpatient benefit

Answer

Inpatient rehabilitation facility stays are covered under Medicare Part A as an inpatient benefit.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Treatment Planning & Management 2