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CH 40 INTRODUCTION TO HEALTH CARE LAW AND ETHICS
The purpose of the Federal Register is to Multiple select question. inform citizens of their rights and obligations. provide a forum for public particip... [Show More] ation in the democratic process. inform healthcare providers of upcoming coding audits. document the actions of federal agencies. - correct answer inform citizens of their rights and obligations. provide a forum for public participation in the democratic process. document the actions of federal agencies. What is the highest law in the United States? Multiple choice question. Federal law State law City law Local law - correct answer Federal law Laws that are enacted by federal and state legislature is called ______ laws. Multiple choice question. statutory executive administrative common - correct answer Statuatory Which of the following is created by judicial decisions made during court trials? Multiple choice question. Common law Administrative law Statutes Executive orders - correct answer Common law Laws that are created and monitored by administrative agencies are called ______ laws. Multiple choice question. administrative executive statutory common - correct answer Administrative The daily journal of the U.S. federal government is called the ______. Multiple choice question. Federal Plan Working Papers Federal Register Bill of Rights - correct answer Federal Register Driving under the influence is considered _____. Multiple choice question. a civil crime a felony legal a misdemeanor - correct answer a misdemeanor Which of the following is the hierarchy of law in the United States? Multiple choice question. Federal laws, state laws, local laws Local laws, state laws, federal laws State laws, federal laws, local laws Federal laws, local laws, state laws - correct answer Federal laws, state laws, local laws Laws that govern the relationships between people and between businesses is known as ______ law. Multiple choice question. administrative criminal common civil - correct answer civil Select all that apply In regards to federal statutes, which of the following statements are true? Multiple select question. HIPAA is an example of a federal law that provides flexibility for state law to be more exact. House and Senate vote on the law to "enact." State and local laws take precedence over federal statutes. Members of Congress are responsible for writing the law. - correct answer HIPAA is an example of a federal law that provides flexibility for state law to be more exact. House and Senate vote on the law to "enact." Members of Congress are responsible for writing the law. As a coder, you should not use a code on a claim form Multiple choice question. without ensuring the nurse has informed the patient. without ensuring the supporting documentation is present. without verifying with the patient. without confirming test results. - correct answer without ensuring the supporting documentation is present The official policies issued by the president of the United States is called executive ______. Multiple choice question. orders summons privilege laws - correct answer orders Which term refers to the process of coding diagnoses and procedures not based on the accuracy of the code, but instead based on what the insurance company will pay for? Multiple choice question. Patient-centered coding Upcoding Unbundling Coding for coverage - correct answer Coding for coverage Who mandates the reporting of infectious diseases? - correct answer CDC Select all that apply Which of the following are types of infractions for criminal activity? Multiple select question. Violation Misdemeanors Conspiracy Felonies - correct answer Misdemeanors Felonies If additional services provided come to light AFTER the claim has already been filed, you must Multiple choice question. file an amended claim. write off the service charge. refile the same claim. file a new claim. - correct answer File an amended claim Violation of a patient's confidentiality is prohibited by what? Multiple choice question. Criminal law Civil law Common law Administrative law - correct answer civil law When is the OIG workplan released each year? Multiple choice question. December 31st January 1st October 1st June 15th - correct answer October 1st Codes indicated on the health claim form must represent the Multiple select question. supporting documentation. services actually performed. service with the most reimbursement. diagnoses used on previous claims. - correct answer Supporting documentation Services actually performed Which of the following is true of the FCA? Multiple choice question. Was enacted by President Bush Makes submission of all insurance claims easier Makes submission of a fraudulent claim to a federal agency illegal Makes submission of Medicare claims easier - correct answer Makes submission of a fraudulent claim to a federal agency illegal Select all that apply Which of the following statements are true regarding coding for coverage? Multiple select question. Coding for coverage means choosing codes based on what the insurance company will pay for. Coding for coverage does not allow patients to get treatment they need paid for by the insurance company. Coding for coverage is dishonest. Coding for coverage is considered fraud. - correct answer Coding for coverage means choosing codes based on what the insurance company will pay for. Coding for coverage is dishonest. Coding for coverage is considered fraud. A demand for money or property made directly to the Federal Government is known as a(n) _____. Multiple choice question. liability acquisition claim requisition - correct answer claim If you resubmit a claim that has been lost, identify it as a(n) _____ to avoid double billing. Multiple select question. tracer new second submission unbundled claim - correct answer tracer second submission Which of the following is also referred to as deliberate ignorance? Multiple choice question. Willful ignorance Actual knowledge Disregard Qui tam provision - correct answer willful ignorance You must code all conditions and complications that are relevant to the _____ encounter(s). Multiple choice question. previous current past 6 past 3 - correct answer current The government rewards the person(s) reporting fraud with a percentage of the total amount recovered by the federal or state government as a result of a qui tam lawsuit. This reward can be _____. Multiple choice question. 15% to 30% 5% to 10% 25% to 50% 30% to 60% - correct answer 15% to 30% To lessen fines and penalties from the OIG, it's best to uncover and correct coding and billing errors Multiple choice question. before auditors show up. after auditors show up. at the request of the OIG. during an OIG audit. - correct answer before auditors show up Select all that apply Who is responsible for ensuring that a facility or provider complies with the False Claims Act? Multiple select question. Billing clerk Coder Compliance officer Patient - correct answer Billing clerk Coder Compliance officer One part of HIPAA is known as the Privacy Rule. This rule was written to Multiple choice question. protect patients' privacy while still allowing flow of information for treatment. protect patients' privacy by requiring their permission before information is shared for treatment. protect providers from lawsuits. allow patients access to their medical records. - correct answer protect patients' privacy while still allowing flow of information for treatment. The False Claims Act's specific definition of claim states, "a _____ for money or property made directly to the Federal Government or to a contractor, grantee, or other recipient." Multiple choice question. demand bill call request - correct answer demand Select all that apply Who is responsible for obeying the HIPAA Privacy Rule? Multiple select question. Health care clearinghouse Physician's office Insurance carrier Patient Dental office - correct answer Health care clearinghouse Physician's office Insurance carrier Dental office Select all that apply Which of the following empowers private citizens to file a lawsuit on behalf of the federal or state government against a facility for noncompliance? Multiple select question. Whistleblower Statute False Claims Act Health Information Portability and Accountability Act Qui tam provision - correct answer Whistleblower Statute Qui tam provision Which of the following statements is true? Multiple choice question. A coder only sees a patient's current diagnosis. A coder can discuss a friend's condition with coworkers. A coder sees patients' past and present health history. A coder only sees the physician's notes in the patent's medical record. - correct answer A coder sees patients' past and present health history Which of the following terms refers to the sharing of information between individuals working for the same entity? Multiple choice question. Use Disclosure Privacy Relevance - correct answer Use Under HIPAA's Privacy Rule, which individuals have access to the patient record without the need for patient permission? Multiple select question. Coder Security Therapist Janitor - correct answer Coder Therapist Select all that apply Which of the following are true regarding a Release of Information form? Multiple select question. Identifies organization that will be disclosing information Does not allow for retraction of authorization Contains an expiration date Written in plain language - correct answer Identifies organization that will be disclosing information Contains an expiration date Written in plain language Select all that apply [Show Less]
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2023 UHC CERTIFICATIONS
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? - correct answer ... [Show More] Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility requirements. Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? - correct answer When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan. Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? - correct answer Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) - correct answer 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits. 2. MA Plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? - correct answer Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? - correct answer Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? - correct answer (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. What is true about Medicare supplement open enrollment? - correct answer (INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement Insurance Plan. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? - correct answer The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? - correct answer Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member must cancel their Medicare Supplement Insurance policy according to their carrier's rules. Which of the following best defines Medicare Part D? - correct answer It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. Which of the following is a fact about Medicare Prescription Drug Plans? - correct answer To enroll, member must be in plans service area What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) - correct answer Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage Which of the following statements does NOT correctly define prescription drug stages? - correct answer A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. Which of these statements is NOT true about the drug utilization management (UM) rules? - correct answer (INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM rules What is the amount added to the member's monthly plan premium if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days? - correct answer Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? - correct answer Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: - correct answer A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? - correct answer Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. - correct answer True Which of the following is NOT true of Medicare Supplement Insurance Plans? - correct answer (INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. Which of the following consumers are eligible for Medicare if other eligibility requirements are met? - correct answer Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - correct answer An MA Plan is a health plan option approved by Medicare and offered by private insurance companies. An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? - correct answer Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? - correct answer HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? - correct answer She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? - correct answer A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? - correct answer A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - correct answer They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? - correct answer Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? - correct answer Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for ______________. - correct answer 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? - correct answer Through subsidies such as lower or no monthly plan premiums and lower or no copayments Which of the following lists drug tiers from least expensive cost share to most expensive cost share? - correct answer Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? - correct answer Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? - correct answer Insured members have the freedom to choose any doctor who accepts Medicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on Jul [Show Less]
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UHC ETHICS AND COMPLIANCE TEST 2020
In terms of events, which of the following is true? A) Agents must report formal marketing/sales events only to UHC B) Agents must report informal market... [Show More] ing/sales events only to UHC C) Agents must report all marketing/sales and educational events to UHC D) Agents must report formal and informal marketing/sales events only to UHC - correct answer Not A Whose email address may the agent enter into the LEAN enrollment application? A) The consumer's or another individual's provided by the consumer, such as a friend's or relative's B) Only the consumer's (or leave it blank) C) Either the consumer's or the agent's, but only if the consumer authorizes it - correct answer B) Only the consumer's (or leave it blank) Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? A) Special Election Period (SEP) B) Initial Coverage Election Period (ICEP) C) Open Enrollment Period (OEP) D) Annual Election Period (AEP) - correct answer D) Annual Election Period Dino, an agent, received a phone call on Sept. 29 from a consumer interested in Medicare Advantage plans for the new year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until Oct. 15. What did Dino do that was NOT compliant? A) Dino did nothing that was non-compliant B) Dino refused to take the enrollment application until Oct. 15 C) Dino presented a plan prior to Oct. 1 - correct answer C) Dino presented a plan prior to Oct. 1 You have scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When you arrive at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should you do? A) Before you can start the appointment with both consumers, ask the consumer's friend to complete an SOA B) Ask the consumer's friend to complete the SOA and schedule a separate appointment C) Tell the consumer that you will come back on another day D) Ask the consumer's friend to leave since she had not scheduled the appointment. - correct answer A) Before you can start the appointment with both consumers, ask the consumer's friend to complete an SOA Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? A) Formal marketing/sales events. B) Educational events C) Personal/individual marketing appointments D) Informal marketing/sales events - correct answer B) Educational events Janine, currently enrolled in a 3-star plan, discovers there is a 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: A) Josh should tell Janine that she can change her current plan to a 5-star plan since one is available in the area where she lives. B)Josh should tell Janine that she can only use the 5-star SEP once per calendar year C) Josh should tell Janine that the new coverage will start the first month after she enrolls in the 5 star plan D) Josh should tell Janine that she can only change her current plan to a 5 star plan during the Annual Election Period - correct answer D) Josh should tell Janine that she can only change her current plan to a 5 star plan during the AEP Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? A) At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older B) At each appointment he provides extra business cards to the consumer and asks that they pass them along to acquaintances C) After enrolling a consumer, he mails a thank you card from the UHC Toolkit and encloses a few business cards for the new member to pass along to acquaintances. - correct answer A) At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older Agent Ralph wants to market Advantage Plans in his neighborhood - an area that consists of single-family houses, an assisted living facility, a church, and public library. Which of the following methods of contact is permitted? A) Ralph sends a flyer inviting consumers to a marketing/sales event to each resident via postal mail B) Ralph puts a flyer inviting consumers to a marketing/sales event on the door of each house. C) Ralph stands in the lobby of the assisted living facility and hands out to the residents a flyer inviting them to a marketing/sales event. D) Ralph puts a flyer inviting consumers to a marketing/sales event on the windshield of each car in the church parking lot on Sunday morning. - correct answer Not C John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? A) John may sign the Enrollment Application and must be able to provide documentation upon request by the plan that indicates his authority under state law to enroll his mother B) John may sign the Enrollment Application, but does not need to provide documentation to support his claim of authority upon request by the plan [Show Less]
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UHC 2021 ETHICS AND COMPLIANCE TEST
Agent Kim is conducting an event that has been advertised as educational. Which activities are permitted at an educational event? - Displaying and distribu... [Show More] ting business cards and lead cards, scheduling one-on-one marketing appointments, and obtaining scope of appointment forms. An individual with Power of Attorney is an example of what authority? - Legal authority under state law to act on behalf of another individual. Who has the authority to sign an Enrollment Application? - The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). Which of the following statements is true about the Statement of Understanding? - It ensures that when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. What is the definition of Waste? - Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. Which of the items listed are examples of Fraud, Waste, and Abuse (FWA)? (Select 3) - Billing for brand name drugs when generics were dispensed. Submitting claims for services or supplies that were never provided. Consulting with a number of doctors in order to obtain multiple prescriptions for the same drug. What type of events must an agent report to UnitedHealthcare? - Formal and informal marketing/sales events Whose email address may the agent enter into the LEAN enrollment application? - Only the consumer's (or leave it blank). Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? - Yes, he needs to obtain a SOA from both Mr. and Mrs. Nelson. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? - [Show Less]
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UHC ETHICS
reporting all events (marketing/sales and educational) to united health care is required so that the company can: - correct answer Comply with CMS and medi... [Show More] caid services event reporting You have a scheduled appointment with a consumer to discuss DSNP. They have the SOA form. 2 days before the appointment they call and request to discuss PDP, which you are certified to sell. What do you tell them? - correct answer tell the consumer to sign a new SOA before the appointment which election period occurs october 15 to december 7 - correct answer AEP Which of the following materials is an agent not permitted to display at marketing/sales event? - correct answer 5$ gift cards You have scheduled an appointment and obtained a SOA form to discuss MA plans. When you arrive a friend wants to hear the presentation. What should you do? - correct answer HAve friend sign an SOA which describes the purpose of educational events? - correct answer They offer information about the program and/or health tips Janine is enrolled in a 3 star plan. There is a 5 star plan in her area. Josh can advise her of the following except: - correct answer Josh shoud tell her that she can only do this during AEP Bryan wants to grow his bussiness. Which of the lead generating activities is not compliant? - correct answer AT each appointment he asks for name and number of people over 65 Ralph wants to market in his neigherhood. WHich of the methods is permitted? - correct answer Not hands out cards in lobby of living center An individual with a POA is an example of what authority? - correct answer must have state authority Which of the following is not considered unsolicited contact? - correct answer Not emailing a consumer off a purchased list Who has the authority to sign an enrollment application? - correct answer The consumer or their legal rep WHich of the following must you nnot do when marketing UHC MA or PDP to consumers - correct answer Provide only those items you deem relevant In what product should you enroll consumers - correct answer Product that meets consumers needs and goals What is the purpose of a statement of understanding? - correct answer Their understanding that they are actually enrolling and standard disclosures What is the definition of waste - correct answer Not practices that result in services not medically necessary What are ways to report potential FWA Pick 2 - correct answer PHD and FWA hotline In terms of events which is true? - correct answer Repot all events. Marketing sales and educational When does permission to contact for MA or PDP expire - correct answer Once contact is made or 9 months whichever comes first A consumer can't understand you and tells you to email for her cousin. you email the the next day. Have you been compliant? - correct answer No violates CMS guidelines without consent first John has POA for his mom. WHat foes that mean for enrolling his mom in MA plan? - correct answer May sign and must be able to provide POA [Show Less]
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UHC ETHICS AND COMPLIANCE 2022
What type of events must an agent report to United Healthcare? -Informal marketing,/sales events only -Formal and informal marketing/sales events -Fo... [Show More] rmal marketing/sa[es events only -Marketing/sales events (formal and informal) and educational events - correct answer Formal and informal marketing/sales events When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? -The consumer/member would not receive plan related correspondence intended for him/her. -The agent may experience commission payment processing issues. -The enrollment application may be denied. - correct answer The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? -Annual Election Period (AEP) -Special Election Period (SEP) -Open Enrollment Period (OEP) -Initial Coverage Election Period (ICEP) - correct answer AEP Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? -Generic business reply cards for Medicare products. -Medicare Made Clear brochures from the UnitedHealthcare Toolkit. -5-dollar gift cards to an in-network pharmacy. -Pens and notepads that contain the agent's contact information. - correct answer 5-dollar gift cards to an in-network pharmacy. Kira has scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When she arrives at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should Kira do? -Ask the consumer's friend to leave since the friend had not scheduled the appointment. -Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA. -Ask the consumer's friend to complete the SOA and schedule a separate appointment. -Tell the consumer that you will come back another day, - correct answer Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA. Educational events allow for which of the following to occur? -Provide objective information about the Medicare program and/or health improvement and wellness. -Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event. -Provide an opportunity to steer a consumer toward a specific or limited number of plans. -Provide an opportunity to review benefits, premiums, and product information with consumers. - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? -Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. Brenda should tell Melanie that the Star Ratings helps consumers and members compare plans based on quality and performance. -Brenda should tell Melanie that Medicare indicates a plan's overall performance and quality with 1 to 5 stars; 1 star denotes poor quality and 5 stars represent excellent quality. -Brenda should tell Melanie that Medicare uses several measures to determine how well plan sponsors perform. Detecting and preventing illness is one example of the measures Medicare uses. - correct answer Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. Which of the following describes Permission to Contact guidelines? -It allows the agent to discuss the products identified during the marketing appointment. -It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified), -It does not have to be provided by the consumer but can be provided by the consumer's spouse or adult child. - correct answer It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified) Julie, a consumer, is having difficulty understanding the information her agent, Victor, is presenting at her in-home appointment. She provides Victor with her cousin's telephone number and email address and asks him to explain the plan to her cousin, who frequently assists with her health care decisions. The next day, Victor emails Julie's cousin. Has Victor been compliant? -No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. -Yes. Victor has been compliant. Victor has received permission from Julie to contact her cousin directly. -No. Victor has violated Centers for Medicare and Medicaid Services (CMS) permission to call guidelines. Contacting the consumer by email without their permission is prohibited. If Victor had telephoned Julie's cousin, he would be compliant. - correct answer No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? -John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. -John may sign the Enrollment Application but does not need to provide documentation to support his claim of authority upon request by the Plan. -John may attend a personal/individual marketing appointment with his mother but has no authority to sign the Enrollment Application. -John may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. - correct answer John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. When can telephonic contact with a Medicare eligible consumer be made? -When confirming receipt of mailed information. -When a member has voluntarily disenrolled from a plan. -When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Who has the authority to sign an Enrollment Application? -The consumer, the consumer's spouse, or the consumer's adult child. -The consumer only. -The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). -The consumer or any individual authorized by the consumer. - correct answer The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? -Review out-of-pocket maximum with consumers and explain any exceptions. -Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. -Provide current marketing materials that have been approved by CMS and UnitedHealthcare. -Review and complete the Enrollment Application with consumers. - correct answer Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. An agent should only enroll a consumer in a product: -That meets the interest he/she has in the transaction, for example commissions received for the sale. -That is suitable for the consumer's needs, goals and financial resources. -That provides a financial advantage to a network of providers, -That meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. - correct answer That is suitable for the consumer's needs, goals and financial resources. Which of the following statements is true about the Statement of Understanding? -It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures. -It is not required if the enrollment mechanism is electronic. -It is only required if the enrollment mechanism is electronic. - correct answer It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) A. Billing for medical services or procedures that were actually provided or performed. B. The pharmacy splits the original prescription to receive additional dispensing fees. Cc. Falsifying signatures or medical records. D. Using another person's medical insurance information to obtain prescriptions. - correct answer B, C, D What is the definition of Waste? -Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. -Waste is intentionally misrepresenting or concealing facts to obtain something of value. -Waste includes any practice that results in the provision of services that are not medically necessary. - correct answer Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources.Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? - correct answer On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? - correct answer Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? - correct answer Mailing a marketing brochure to the consumer via postal mail. Which statement is true about discussing benefits with the consumer before an enrollment? - correct answer The agent must accurately and completely disclose any benefits discussed. Which statement about discussing benefits with the consumer before an enrollment is true? - correct answer The agent must explain any provider and/or pharmacy network limitations. While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? - correct answer Leave the field requesting applicant email address blank. What is the purpose of the Statement of Understanding? - correct answer It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. [Show Less]
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UHC ETHICS & COMPLIANCE 2022
Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy w... [Show More] ith his current plan. On the date of the call, what can Gene do about his coverage? - correct answer On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? - correct answer Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? - correct answer Mailing a marketing brochure to the consumer via postal mail. Which statement is true about discussing benefits with the consumer before an enrollment? - correct answer The agent must accurately and completely disclose any benefits discussed. Which statement about discussing benefits with the consumer before an enrollment is true? - correct answer The agent must explain any provider and/or pharmacy network limitations. While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? - correct answer Leave the field requesting applicant email address blank. What is the purpose of the Statement of Understanding? - correct answer It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. What is Scope of Appointment? - correct answer The agreement obtained from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic) Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? - correct answer Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. In which situation MAY the Medicare Advantage (MA) organization disenroll a member from an MA plan? (if question says *must* it is not the same answer) - correct answer Premiums are not paid on a timely basis. Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)? - correct answer Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. As an agent, you have an obligation to enroll a consumer in a product: OR An agent should only enroll a consumer in a product: - correct answer That is suitable for the consumer's needs, goals and financial resources. An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true? - correct answer The agent said that Medicare uses a 5-star rating system to illustrate the plan's performance and quality. Before starting an enrollment, what benefit information are agents required to provide to the consumer? - correct answer The agent must accurately and completely disclose any benefits discussed Whose email address may the agent enter into the applicant information section of LEAN enrollment application? - correct answer Only the consumer's email (or leave it blank). The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. - correct answer Statement of Understanding Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? - correct answer Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) - correct answer Factual Accurate Complete Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: - correct answer Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Why must an agent present accurate, complete, and factuals plan information to consumers? (select 3 - correct answer To help avoid misunderstandings To help the consumer focus on plan-specific information, such as benefits and costs To help avoid confusing the consumer Which election period runs from October 15 to December 7 and allows consumers to join a Medicare Advantage Plan or switch to a different plan? - correct answer Annual Election Period (AEP) A one-on-one marketing appointment, whether in-person or telephonic, is always considered a marketing/sales event, but it is not reported to UnitedHealthcare or CMS; instead the consumer must provide_____ agreement prior to the start of the appointment. - correct answer Scope of Appointment To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? - correct answer The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? - correct answer The consumer/member would not receive plan related correspondence intended for him/her. By agreeing to the Statement of Understanding, the consumer: - correct answer Acknowledges that they clearly understand they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? - correct answer Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)? - correct answer Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP.What is the definition of Abuse? - correct answer Abuse includes any practice that results in the provision of services that are not medically necesary An agent should only enroll a consumer in a product: - correct answer That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - correct answer Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? - correct answer Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. When can telephonic contact with a Medicare eligible consumer be made? - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? - correct answer Legal authority under state law to act on behalf of another individual. Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: - correct answer Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - correct answer Dino presented a plan prior to October 1. Annual Election Period (AEP) is a time when: - correct answer Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? - correct answer Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? - correct answer Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline What is the definition of Fraud? - correct answer Fraud is intentionally misrepresenting or concealing facts to obtain something of value. What is the purpose of the Statement of Understanding? - correct answer It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling and standard disclosures. In what product should agents enroll consumers? - correct answer A product that is suitable for the consumer's needs, goals and financial resources. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? - correct answer Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. To sign an Enrollment Application on behalf of a consumer, what authority must the individual [Show Less]
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UHC ETHIC AND COMPLIANCE 2022
What is the definition of Abuse? - correct answer Abuse includes any practice that results in the provision of services that are not medically necesary ... [Show More] An agent should only enroll a consumer in a product: - correct answer That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - correct answer Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? - correct answer Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. When can telephonic contact with a Medicare eligible consumer be made? - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? - correct answer Legal authority under state law to act on behalf of another individual. Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: - correct answer Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - correct answer Dino presented a plan prior to October 1. Annual Election Period (AEP) is a time when: - correct answer Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? - correct answer Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? - correct answer Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline What is the definition of Fraud? - correct answer Fraud is intentionally misrepresenting or concealing facts to obtain something of value. What is the purpose of the Statement of Understanding? - correct answer It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling and standard disclosures. In what product should agents enroll consumers? - correct answer A product that is suitable for the consumer's needs, goals and financial resources. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? - correct answer Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. To sign an Enrollment Application on behalf of a consumer, what authority must the individual have? - correct answer The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g. Power of Attorney). In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and that the permission has not yet expired. Julie, a consumer, is having difficulty understanding the information her agent, Victor, is presenting at her in-home appointment. She provides Victor with her cousin's telephone number and email address and asks him to explain the plan to her cousin, who frequently assists with her health care decisions. The next day, Victor emails Julie's cousin. Has Victor been compliant? - correct answer No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. When does Permission to Contact for Medicare Advantage and/or Prescription Drug Plans expire? - correct answer Once contact is made or 9 months from the date the consumer provided permission (e.g. consumer signature date on BRC) or 90 days if on federal do not call list, whichever comes first. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? - correct answer Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? - correct answer Educational events Kira has scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When she arrives at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should Kira do? - correct answer Before Kira can start the presentation with both consumers, she must ask the consumer's friend to complete an SOA. Which of the following material is an agent NOT permitted to display and/or distribute at a marketing/sales event? - correct answer 5-dollar gift cards to an in-network pharmacy. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? - correct answer Annual Election Period (AEP). When completing a enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? - correct answer The consumer/member would not receive plan related correspondence intended for him/her.In terms of events, which of the following is true? Agents must only report formal marketing/sales events United Healthcare. Agents must only report informal marketing/sales events to United Healthcare. Agents must only report formal and informal marketing/sales events to United Healthcare. - correct answer ... When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The enrollment application may be denied. The agent may experience commission payment processing issues. - correct answer The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? Open Enrollment Period (OEP) Special Election Period (SEP) Initial Coverage Election Period (ICEP) Annual Election Period (AEP) - correct answer Annual Election Period (AEP) Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? Medicare Made Clear brochures from the UnitedHealthcare Toolkit. Pens and notepads that contain the agent's contact information. 5-dollar gift cards to an in-network pharmacy. Generic business reply cards for Medicare products. - correct answer 5-dollar gift cards to an in-network pharmacy. Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? Yes, but just one because the Nelsons are husband and wife. Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. No, because the Nelsons are current members. No, because the Nelsons walked into his office instead of scheduling an appointment in their home. - correct answer Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Educational events allow for which of the following to occur? Provide objective information about the Medicare program and/or health improvement and wellness. Provide an opportunity to review benefits, premiums, and product information with consumers. Provide an opportunity to steer a consumer toward a specific or limited number of plans. Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event. - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars? Erin should let Mrs. Rose know that the rating is for agent use only and has accidentally been printed in the Enrollment Guide. Erin should tell Mrs. Rose that the plan has received a "Below Average" rating. Erin should tell Mrs. Rose that each plan has the same Star Rating and it does not accurately reflect an individual plan's performance in certain categories. - correct answer ... Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? After enrolling a consumer, he mails a thank you card from the UnitedHealthcare Toolkit and encloses a few business cards for the new member to pass along to acquaintances. At each appointment he provides extra business cards to the consumer and asks that the consumer pass them along to acquaintances. At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. - correct answer At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. Consumer Gary gives his friend's telephone number and email address to agent Bethany. What should Bethany do? Bethany may accept the contact information and telephone or email Gary's friend to schedule a face-to-face meeting. Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. Bethany should ask for Gary's friend's address so she can visit him while she is in the neighborhood. - correct answer Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? John may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. John may attend a personal/individual marketing appointment with his mother but has no authority to sign the Enrollment Application. John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. John may sign the Enrollment Application but does not need to provide documentation to support his claim of authority upon request by the Plan. - correct answer John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When confirming receipt of mailed information. When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. When a member has voluntarily disenrolled from a plan. - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Jacob must explain that Emily will sign the Enrollment Application and that no further action on her part is required. Jacob must explain that Emily will sign the Enrollment Application and must submit documentation with the application that indicates her legal authority to enroll her father. Jacob must explain that Emily is not authorized to complete the Enrollment Application on behalf of her father. - correct answer jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. [Show Less]
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UHC ETHICS AND COMPLIANCE
In terms of events, which of the following is true? Agents must only report formal marketing/sales events United Healthcare. Agents must only report info... [Show More] rmal marketing/sales events to United Healthcare. Agents must only report formal and informal marketing/sales events to United Healthcare. - correct answer ... When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The enrollment application may be denied. The agent may experience commission payment processing issues. - correct answer The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? Open Enrollment Period (OEP) Special Election Period (SEP) Initial Coverage Election Period (ICEP) Annual Election Period (AEP) - correct answer Annual Election Period (AEP) Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? Medicare Made Clear brochures from the UnitedHealthcare Toolkit. Pens and notepads that contain the agent's contact information. 5-dollar gift cards to an in-network pharmacy. Generic business reply cards for Medicare products. - correct answer 5-dollar gift cards to an in-network pharmacy. Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? Yes, but just one because the Nelsons are husband and wife. Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. No, because the Nelsons are current members. No, because the Nelsons walked into his office instead of scheduling an appointment in their home. - correct answer Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Educational events allow for which of the following to occur? Provide objective information about the Medicare program and/or health improvement and wellness. Provide an opportunity to review benefits, premiums, and product information with consumers. Provide an opportunity to steer a consumer toward a specific or limited number of plans. Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event. - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars? Erin should let Mrs. Rose know that the rating is for agent use only and has accidentally been printed in the Enrollment Guide. Erin should tell Mrs. Rose that the plan has received a "Below Average" rating. Erin should tell Mrs. Rose that each plan has the same Star Rating and it does not accurately reflect an individual plan's performance in certain categories. - correct answer ... Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? After enrolling a consumer, he mails a thank you card from the UnitedHealthcare Toolkit and encloses a few business cards for the new member to pass along to acquaintances. At each appointment he provides extra business cards to the consumer and asks that the consumer pass them along to acquaintances. At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. - correct answer At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. Consumer Gary gives his friend's telephone number and email address to agent Bethany. What should Bethany do? Bethany may accept the contact information and telephone or email Gary's friend to schedule a face-to-face meeting. Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. Bethany should ask for Gary's friend's address so she can visit him while she is in the neighborhood. - correct answer Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? John may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. John may attend a personal/individual marketing appointment with his mother but has no authority to sign the Enrollment Application. John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. John may sign the Enrollment Application but does not need to provide documentation to support his claim of authority upon request by the Plan. - correct answer John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When confirming receipt of mailed information. When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. When a member has voluntarily disenrolled from a plan. - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Jacob must explain that Emily will sign the Enrollment Application and that no further action on her part is required. Jacob must explain that Emily will sign the Enrollment Application and must submit documentation with the application that indicates her legal authority to enroll her father. Jacob must explain that Emily is not authorized to complete the Enrollment Application on behalf of her father. - correct answer jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers? Review the Summary of Benefits. Review and complete a SOA form with each Medicare-eligible consumer prior to the start of a personal/individual (e.g., in-home or telephonic) marketing appointment. Provide current materials approved by CMS and UnitedHealthcare. Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. Next question - correct answer Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. As an agent, you have an obligation to only enroll a consumer in a product: That meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. That is suitable for the consumer's needs, goals and financial resources. That provides a financial advantage to a network of providers. That meets the interest you have in the transaction, for example commissions received for the sale. - correct answer That is suitable for the consumer's needs, goals and financial resources. By signing the Statement of Understanding, the consumer: Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. Acknowledges their understanding of standard enrollment and disenrollment procedures. Acknowledges that the agent may discuss Medicare Advantage and Prescription Drug Plans with the consumer. - correct answer Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. What is the definition of Abuse? Abuse includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. Abuse includes any practice that results in the provision of services that are not medically necessary. Abuse is intentionally misrepresenting or concealing facts to obtain something of value. - correct answer Abuse includes any practice that results in the provision of services that are not medically necessary. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) Falsifying signatures or medical records. Billing for medical services or procedures that were actually provided or performed. The pharmacy splits the original prescription to receive additional dispensing fees. Using another person's medical insurance information to obtain prescriptions. - correct answer Falsifying signatures or medical records. The pharmacy splits the original prescription to receive additional dispensing fees. Using another person's medical insurance information to obtain prescriptions.Agent John is planning to conduct a series of events. Some will be strictly educational, others will be formal presentations of specific United Healthcare plans, and others will be informal marketing events where he can generate leads and schedule future in-home marketing appointments. Of the three types of events John plans to conduct, which need to be reported to United Healthcare? - correct answer ******* When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? - correct answer The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? - correct answer Annual Election Period (AEP) Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - correct answer Dino presented a plan prior to October 1. Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? - correct answer Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. [Show Less]
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UHC 2022 ETHICS AND COMPLIANCE TEST
Agent John is planning to conduct a series of events. Some will be strictly educational, others will be formal presentations of specific United Healthcare ... [Show More] plans, and others will be informal marketing events where he can generate leads and schedule future in-home marketing appointments. Of the three types of events John plans to conduct, which need to be reported to United Healthcare? - correct answer ******* When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? - correct answer The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? - correct answer Annual Election Period (AEP) Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - correct answer Dino presented a plan prior to October 1. Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? - correct answer Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Which describes the purpose of educational events? - correct answer Educational events provide objective information about the Medicare program and/or health improvement and wellness. How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars? - correct answer Erin should tell Mrs. Rose that the plan has received a "Below Average" rating. Which of the following describes Permission to Contact guidelines? - correct answer It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified). Julie, a consumer, is having difficulty understanding the information her agent, Victor, is presenting at her in-home appointment. She provides Victor with her cousin's telephone number and email address and asks him to explain the plan to her cousin, who frequently assists with her health care decisions. The next day, Victor emails Julie's cousin. Has Victor been compliant? - correct answer No. Victor violated United Healthcare permission to contact guidelines by emailing the cousin without the cousin's permission Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? - correct answer The consumer's spouse, who is neither a Power of Attorney nor legal guardian. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? - correct answer Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers? - correct answer Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. An agent should only enroll a consumer in a product: - correct answer That is suitable for the consumer's needs, goals and financial resources. What is the purpose of the Statement of Understanding? - correct answer It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. What is the definition of Abuse? - correct answer Abuse includes any practice that results in the provision of services that are not medically necessary. Which of the following are the ways to report potential FWA? (Select 2) - correct answer -Fraud, Waste and/or Abuse hotline -Producer Help Desk (PHD) In terms of events, which of the following is true? - correct answer Agents must only report formal and informal marketing/sales events to UnitedHealthcare. Whose email address may the agent enter into the LEAN enrollment application? - correct answer Only the consumer's (or leave it blank) Annual Election Period (AEP) is a time when: - correct answer Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. Agent Kim is conducting an event that has been advertised as educational. Which activities are permitted at an educational event? - correct answer the one with scope of appointments in the answer Educational events allow for which of the following to occur? - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? - correct answer Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? - correct answer John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. To sign an Enrollment Application on behalf of a consumer, what authority must the individual have? - correct answer The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g. Power of Attorney). When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - correct answer Provide current marketing materials that have been approved by CMS and UnitedHealthcare. What is the definition of Waste? - correct answer NOT***** Waste includes any practice that results in the provision of services that are not medically necessary. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) - correct answer - Falsifying signatures or medical records. - The pharmacy splits the original prescription to receive additional dispensing fees. - Using another person's medical insurance information to obtain prescriptions. Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? - correct answer 5-dollar gift cards to an in-network pharmacy. Rina, a consumer, has requested an appointment with Connor, an agent, to discuss DSNPs. Prior to the appointment Rina completed a Scope of Appointment (SOA) form. On the day of the appointment, Rina brings her friend Shelley, who is Medicare-eligible, to the meeting. Shelley also wants to talk about DSNPs. What should Connor do when he sees both Rina and Shelley at the appointment? - correct answer Ask Shelley to complete an SOA before the start of the meeting. Educational events allow for which of the following to occur? - correct answer Provide objective information about the Medicare program and/or health improvement and wellness. Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? - correct answer At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? - correct answer Mailing a marketing brochure to the consumer via postal mail. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? - correct answer Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. By signing the Statement of Understanding, the consumer: - correct answer Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling.According to FAR 15.4, which of the following is one of the two most preferred price analysis techniques? - correct answer Comparison of proposed prices received in response to the solicitation * How may you request an audit? - correct answer All of these are correct A "questioned cost" is one that has not yet been evaluated. - correct answer False * [Show Less]
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