CMS Treatment Planning & Management 3 — Questions and Answers
Question 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?
- Medicare Part A skilled nursing benefit
- Medicare hospice benefit (Correct answer)
- Medicare Part B palliative care benefit
- Medicare Advantage supplemental benefit only
Correct answer: Medicare hospice benefit
The Medicare hospice benefit covers comprehensive comfort-focused care for terminally ill beneficiaries who forgo curative treatment.
Question 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?
- Nursing visits and pain medication
- Social work counseling and chaplain services
- Curative chemotherapy for the terminal illness (Correct answer)
- Short-term inpatient respite care
Correct 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.
Question 3: What is the maximum number of days Medicare covers in an SNF at full benefit (no copayment) during a benefit period?
- 10 days
- 20 days (Correct answer)
- 30 days
- 60 days
Correct answer: 20 days
Medicare covers days 1–20 in an SNF with no coinsurance; days 21–100 require a daily coinsurance amount.
Question 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?
- Medicare Part B will automatically pay the claim
- The claim may be denied and the beneficiary could be liable for the cost (Correct answer)
- The plan must cover the MRI as a medically necessary service regardless
- CMS will intervene and approve the MRI within 72 hours
Correct 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.
Question 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?
- Physical therapy
- Occupational therapy (Correct answer)
- Speech-language pathology
- Respiratory therapy
Correct answer: Occupational therapy
Occupational therapy helps patients regain skills needed for activities of daily living and is covered under Medicare Part B.
Question 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)?
- 10 minutes
- 15 minutes
- 20 minutes (Correct answer)
- 30 minutes
Correct answer: 20 minutes
CPT 99490 requires at least 20 minutes of clinical staff time per calendar month for chronic care management services.
Question 7: A beneficiary enrolled in Original Medicare undergoes surgery and requires post-acute care coordination. Which resource helps ensure smooth transitions and reduce readmissions?
- Medicare Prescription Drug Plan formulary
- Transitional Care Management (TCM) services (Correct answer)
- Medicare Part D Extra Help program
- Medigap Policy F coverage
Correct 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.
CMS Treatment Planning & Management 3
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?