3.3 Flashcards
A Medicare patient was undergoing a procedure that was considered not medically necessary for Medicare reimbursement based on the patient’s diagnosis. The surgery technician present to the ABN appropriately to the patient but the patient refused to sign the ABN. The surgery technician documented on the ABN that the patient refused to sign. The technician asked the nurse to witness the patient’s refusal to sign. The patient insisted on undergoing the procedure in the surgeon agreed to perform the service. Medicare denied the service, because the diagnosis did not support medical necessity for the service. What is the most appropriate action?
D. The hospital may bill the patient and collect the full amount of the bill.
And ABN rendered in a timely manner is important for the facility to receive payment when the services not covered by Medicare. The facility may:
A. Notify the patient well in advance of the service being provided.
B. Have the patient sign the ABN after the services performed
C. Have the patient sign the ABN routinely after the patient is prepared for the service or procedure.
D. Have the patient sign the ABN after administration of anesthesia
A. Notify the patient well in advance of the service being provided.
In ABN was presented to a 68-year-old Medicare patient for services that might not be covered the services that you might be denied were specified on the ABN. The ABN did not specify the reason Medicare might likely deny the claim. The patient signed the ABN in the claim was denied the patient received a bill from the facility and question the fact that she did not understand the ABN or what was actually being signed. Is the patient responsible for the payment? Select the correct answer:
A. The patient is responsible for payment since she signed the ABN
B The ABN did not specify the reason Medicare might not deny the claim so the patient is not responsible for the payment
C The patient is responsible for payment and may appeal to Medicare
D none of the above
B The ABN did not specify the reason Medicare might not deny the claim so the patient is not responsible for the payment
The purpose of an ABN is to:
A notify the patient that the item or service is lawfully excluded
B notify the patient that the item or service may be covered and to make sure the patient is aware of the charges
C notify the patient that the item or service may not be covered
D notify the patient that the service will be covered under specific conditions
C notify the patient that the item or service may not be covered
The second level of the Medicare appeal process involves a claim review by each of the original parties (eg provider and carrier.) A. Departmental appeals Board of review B. Redetermination C. Reconsideration D. Administrative law judge
C. Reconsideration
Condition code 21 is reported when:
A. The item or service is not covered under statute, but the patient or other pair request for services billed for a denial
B. The patient demands the bill is submitted
C. The service may not be covered but the facility is not certain
D. The service is typically covered
A. The item or service is not covered under statute, but the patient or other pair request the services billed for a denial
The levels of Medicare appeal in the correct order are:
B. Redetermination, reconsideration, administrative law judge, departmental appeals Board review, judicial review in the US circuit District Court
A patient underwent a routine Pat and pelvic examination and GYN outpatient hospital clinic. The patient has a Pap and pelvic examination one year ago. Since the services covered for the preventative screening every two years the service will not be covered. The clinic and did not have the patient sign the ABN. The clinic nurse did tell the patient the services would not be covered, but the patient insisted that the facility file Medicare benefits as she insists Medicare covers the service. What modifier will the facility append to the service?
GL
GA
GZ
GY
Even when a patient seeks care in an emergency department, and an ABN would not be appropriate until the hospital has met its obligations under what act??
EMTALA Emergency medical treatment in active labor act
A Medicare patient is scheduled for procedure that Medicare does not lawfully pay for. The facility asked the patient to sign the ABN, but the patient refuses. But the silly bills the patient for the service and the patient refuses to pay. Is the patient liable in this situation?
When the statue excludes the service, and ABN is not necessary and refusal to sign the ABN does not exempt patient from payment responsibility
