CMS Study Guide 2026

Everything you need to pass the CMS exam in one place: the exam format, every topic to study, real practice questions with explanations, flashcards, and full-length practice tests. Free, no sign-up needed.

📚 CMS Topics to Study (75)

See all 75 topics as flashcards →

✍️ Sample CMS Questions & Answers

1. Under the Medicare Fee Schedule, what three components make up a procedure's Relative Value Unit (RVU)?

✓ Physician work, practice expense, and malpractice expense

Each CPT code's total RVU is the sum of three components: physician work RVU, practice expense RVU, and malpractice (professional liability insurance) expense RVU.

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

✓ The beneficiary's primary care physician typically coordinates care

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

3. How does Medicare coordinate benefits when a beneficiary is covered by both Medicare and an employer group health plan from a small employer (fewer than 20 employees)?

✓ Medicare is primary and the employer group health plan is secondary for small employers

For employers with fewer than 20 employees, Medicare is the primary payer and the employer group health plan pays secondary, unlike large employers where the group plan pays first.

4. A Medicare-certified ambulatory surgical center (ASC) must implement which minimum safety standard to prevent patient falls in the procedure area?

✓ Non-slip flooring and secured equipment pathways with fall risk assessments

CMS requires ASCs to maintain a safe physical environment with fall prevention measures, including non-slip surfaces and pre-procedure fall risk assessments.

5. What does Medicare Part B typically cover in terms of billing?

✓ Outpatient services and preventive care

Medicare Part B typically covers outpatient services and preventive care. This includes doctor's visits, outpatient therapy, durable medical equipment, mental health services, and various screenings and vaccinations. It helps cover costs for services received outside of an inpatient hospital stay, which is generally covered by Part A.

6. Which of the following best describes confidentiality in Certified Medicare Specialist?

✓ Protecting sensitive information from unauthorized disclosure

Confidentiality involves protecting sensitive information and only sharing it with authorized parties who need it.

🎯 Free CMS Practice Tests

Emergency Procedures & Response · 7 questions Medical Terminology & Anatomy · 7 questions Medical Terminology & Anatomy · 7 questions Medicare Specialist Coverage Planning Options · 7 questions Medicare Specialist Enrollment & Eligibility Guidelines · 7 questions Medicare Specialist Regulatory Compliance & Patient Advocacy · 7 questions Quality Assurance & Standards · 7 questions Quality Assurance & Standards · 7 questions Safety & Infection Control · 7 questions Emergency Procedures & Response · 7 questions

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Your CMS Study Path

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🃏 CMS Flashcards (501)

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