Medicare
What is the Internal Support Group (ISG)?
• ISG is a group of CSRs that help CSRs like you. • They help you assist your caller if you are ever unsure of what to do or how to handle a call.
If a caller partially passes disclosure through the IVR, what information are you required to verify before you can provide beneficiary-specific information to them?
• If the beneficiary provided only some items through the IVR, make sure that you verify their first and last names and ask them for the remaining pieces. Once you have verified a total of four pieces of information, the beneficiary has passed disclosure and you can release any beneficiary-specific information to them.
How many plans can you compare at a time?
3
Which view on the BCC Tier 1 screen shows you information about a beneficiary's premium?
Premium Summary
How many months have 28 days?
Every month has 28 days.
What are the 4 phases of the Call Management Framework?
• Phase 1 Receive the Call • Phase 2 Listen, Question, and Confirm • Phase 3 Provide Solutions • Phase 4 Transfer or Close the Call
Where and how do you search for scripts in NGD?
Click on the Welcome Mat button to open the Content Viewer. This is where you will search for scripting, reference materials, and other resources to help you on a call.
A beneficiary would like to know if he can enroll in Part A and Part B now. Which script would provide the needed information?
Part A and Part B Eligibility and Enrollment
Sandra Adams is 72 years old and works full-time for ABC Casket Company. The company has 75 employees. She has group health coverage through her employer. Who are her primary and secondary payers?
Medicare is the primary.
Employer coverage is secondary
Which artist performed the 2023 Super Bowl halftime?
Rihanna
List the four parts of Medicare and describe what they cover
• Part A (Hospital insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice, and home health care. • Part B (Medical insurance) helps cover medically necessary services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and many preventive services. • Medicare Advantage (MA), also known as Part C. Private companies work with Medicare to bundle Part A and Part B, often including Part D, and some offer extra benefits such as vision and dental. In most cases, you will need to use doctors who are in the plan’s network. • Part D (Drug coverage) is insurance from private companies that work with Medicare to help cover the cost of prescription drugs. You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage
List the enrollment periods for which a person is eligible to enroll into Medicare.
• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Period(s)
• Transfer Enrollment Period
What indicator lets the CSR know that there is already a complaint on file
Open Escalation
Paul Green is a veteran. He likes to go to his local VA hospital when he needs inpatient care. Those claims are filed through the VA program. He has plans to go to the regular doctor and wants to have the claims filed with Medicare. Can Mr. Green do this?
Since Mr. Green is a veteran and has both veterans’ benefits and Medicare, he can choose who to file the claim with on a claim-by-claim basis. Explain that this is a common scenario
Two fathers and two sons are in a car, yet there are only three people in the car. How?
They are grandfather, father, and son.
Which two privacy laws govern how protected health information (PHI) and personally identifiable information (PII) are handled?
• The Privacy Act of 1974
• The Health Insurance Portability and Accountability Act (HIPAA)
What are the penalties for not enrolling into a prescription drug plan when first eligible to do so?
Late Enrollment Penalty
How long does beneficiary have to enroll in Medicare if they delayed because they were receiving employer sponsored coverage?
: Eight months after the month when the employer or union group health plan coverage ends or 8 months after employment ends, whichever comes first
Carol Clark calls 1-800-MEDICARE on October 1 and asks if she can switch to a different MA plan and get a new drug plan. She does not qualify for any special election periods. What information must you give Mrs. Clark?
Carol Clark cannot switch MA plans or add a PDP until the OEP (October 15 – December 7).
What team took home the Vince Lombardi Trophy in the 2025 Super Bowl?
The Philadelphia Eagles
Name the 7 Quality Now skills
• Issue Resolution
• Call Efficiency
• Active Listening
• Personality Flexing
• Business Process
• Information Accuracy
• Privacy and Disclaimers
What date range should you use to search for this claim? If the D.O.S is May 16, 2025?
May 1, 2025 – May 31, 2025
What were the dates of a beneficiary's initial enrollment period if their birthday was August 6, 2024?
May 1, 2024 – November 30, 2024
How do beneficiaries pay their IRMAA? Include all the options listed in scripting
The same payment options
Easy Pay
Check or money order
Credit/ Debit
What is always on its way but never arrives?
Tomorrow