Medicare

History

100

Which part of Medicare originally cover Hospital Insurance?

Part A 

200

in 2003 the Modernization Act added what part to Medicare?

Part D

300

in what year Medicare started covering telehealth due to covid-19?

2020

400

President who signed Medicare into law?

Lyndon B. Johnson 

500

Today, Approximately how many American are covered by Medicare?

60 million 

QA

100

1. What are the five sections on the Audit Tool?

1.Call Handling 2. Sales Presentation 3. Enrollment 4. Documentation 5. Compliance (Auto-Fails)

200

1. How many calls are audited a week for each agent?

4 Calls

300

1. What is the passing score for QA?

 92% and above

400

1. What is the correct process for dispute submissions?

meet with sup, review call, submit

500

1. What tab is used to review completed audits in Calabrio?

Interactions Tab

Compliance

100

1. What is the lookback period for CTM/GRV history?

12 months

200

1. What do you call a member complaint that has been submitted internally, usually through customer service?

Grievance

300

1. What do you call a formal complaint made by a member/prospective member through CMS/1-800-Medicare?

CTM

400

1. What department is responsible for investigating marketing CTMs and grievances?

CIU

500

1. What is the department goal for CTM per K Rate?

30%

AEP

100

What are the dates of AEP?

October 15th-December 7th

200

If someone enrolls using AEP 11/3/25 when will their plan start?

January 1st 2026

300

Where would we find tools and resources if one or more systems were down or not working during AEP?

Centralpoint – Pre-Enrollment and SPOP links

400

It is 11/24/2025 and Mr. Jones just retired at 65 and got his Medicare A and B to start 12/1/2025. What SEP and effective date will he have?

IEP and 12/1/2025

500

You talk to someone during AEP in PA and they want the dual plan like their friend. They live in the DSNP area, have the right level of Medicaid but they don't have PA Health & Wellness for their MCO, what do you do?

Enroll for AEP, MCO only matters when using the INT SEP.

Sales

100

What does MAPD stand for?

Medicare Advantage Prescription Drug

200

What document summarizes a plan's copays, premiums, and benefits in an easy-to-read format?

Summary of Benefits (SOB)

300

What does LIS stand for, and what is the more common name beneficiaries may know it by?

Low-Income Subsidy; Extra Help

400

Name the enrollment period that runs from January 1 to March 31, allowing members to make a one-time change

Open Enrollment Period (OEP)

500

current Wellcare MAPD member calls and says they’ve recently moved from Sacramento, CA to San Diego, CA, which are in different counties. They are requesting to enroll in a new Wellcare plan available in their new area. What do you do?

 In our department, the Change of Residence/Move SEP cannot be used on a current Wellcare MAPD member unless it is a State-to-State move.