Medicare

Question 1

Part A

Answer 1

Hospital insurance

Helps pay for inpatient hospital, skilled nursing, and hospice at no charge to beneficiaries

Question 2

Part B

Answer 2

Medical insurance
Voluntary program, available upon payment of a premium
To individuals entitled to part A
65 years, are residents or lived in US for five consecutive years)

(Most services fall under this. Medicare will pay 80% of claim and the pt is responsible for remaining 20%

Question 3

Part C

Answer 3

HMO (advantage plans) beneficiary signs over their benefits to a privately managed HMO. O&P providers must obtain a pre-authorization to provide services.

Question 4

Part D

Answer 4

Prescription drug benefits

Question 5

4 regional contractors for processing claims for O and P:

Answer 5

DME MACs- durable medical equipment Medicare administrative contractors
Jurisdictions A,B,C,D

Question 6

How many HCFA regional fees schedules:

Answer 6

10 ( do not confusion with 4 DME MAC areas)

Question 7

T or F: routine waiver of deductible and co-insurance by suppliers is unlawful

Answer 7

True

Question 8

What does assignment mean?

Answer 8

Suppliers agree to accept the Medicare fee for that procedure as payment in full except for the applicable 20% co-payment and any unmet deductible.

For o and p provider to accept assignment, pt must sign and date block 12 of the 1500 clam form or sign a one time authorization

Question 9

Who issues supplier numbers and maintains records?

Answer 9

The national clearing house(NSC)

Question 10

If you elect to become a Participating supplier..

Answer 10

You must accept assignment for all covered Medicare services

Question 11

What is the major advantage of Non-participating suppliers?

Answer 11

You decide weather to accept assignment on a claim by claim basis

Question 12

L codes form a subsection of what?

Answer 12

Health care financing administration common procedure coding system (HCPCS)

Question 13

REQUIRED documentation

Answer 13

Pt. Intake process
HIPAA
Written orders- detailed px with signed date and signature
Eval and/or progress notes stating medical necessity
Advance Beneficiary notice (ABN)
Delivery slip- form signed
Medicare compliance standard-form signed

Question 14

Requirements for written orders

Answer 14

Needed prior to clam submission
Beneficiary's name
Patient diagnosis
Items/components/ supplies needed
HCPCS narrative for each code
Prescription date
Physician name and address
Physician id code
Signature of treating physician

Question 15

Advanced beneficiary notice:

Answer 15

Is a written notice of non-coverage. It informs beneficiary that Medicare may not pay for an item
Beneficiary liable for payment
Protects supplier from liability
Bene. Receives a copy and the notifier keeps original
If ABN is not signed, the patient cannot be billed for the item

Question 16

Proof of delivery

Answer 16

Delivery slip must be signed and is required to verify the beneficiary received the DEMPOS item- by beneficiary, or bene. Designee

DATE OF SERVICES=DATE OF DELIVERY

Question 17

HOW long must documentation be kept?

Answer 17

10 yrs.

Question 18

A prescription is required to contain which of the following info
A. Patient identification
B. Description of services needed
C. Physician signature
D. Date
E. All of the above

Answer 18

All the above

Question 19

When items are shipped to a patient what documentation must be filed in the patients chart?
A. Shipping invoices and tracking #
B. Validation of receipt
C. Copy of packing slip with specific list of the items sent
D. Shipping service confirmation of delivery
E. All the above

Answer 19

All the above

Question 20

When items are shipped to patients what documents must be included in the package?
A. Cost estimate, VOR and packing slip
B. Packing slip and VOR
C. VOR- The VOR elves as the packing slip

Answer 20

C. VOR- The VOR elves as the packing slip

Question 21

Release of info/ assignment of benefits form must be signed and dated by \_\_\_\_\_and maintained in the patient's file
A. Medicare patients only
B. Hospital patients only
C. Walk-in patients only
D. All patients seen

Answer 21

All patients

Question 22

Billing or invoicing prior to delivery is permitted

Answer 22

False

Question 23

T or F: A warranty must be given to each patient for each device provided and a signed copy or acknowledgment dated on the date of service must be kept in the patients file

Answer 23

T

Question 24

The VOR must include the quantity and description of each procedure code provided/billed

Answer 24

True

Question 25

In case when a patients is unable to sign and date the VOR, Hanger staff may act as the patients qualified representative

Answer 25

False

Question 26

T or F the date of service must always agree with the date of delivery

Answer 26

False

Question 27

T or F: on an unassigned claim, you may not collect more than 20% of the Medicare fee schedule amount and the Medicare deductible

Answer 27

False

provider does not submit paperwork, patient is responsible for submitting paperwork

Question 28

T OR F: All prosthetic services may be billed directly to Medicare for patients residing in acute care or rehabilitation hospitals or during a part-A covered stay in a SNF

Answer 28

FALSE: Soft goods?

Question 29

When shipping items to a patient what is the date of service

Answer 29

The date the item is shipped out of your office

Question 30

T or F: When providing a custom orthotic device documentation of the medical need for custom vs. prefab. Must be included within the patient clinical record

Answer 30

True

Question 31

T or F: When providing a static dynamic AFO/PRAFO for treatment of lower extremity ulcer or pressure reduction the device must be coded as A9283

Answer 31

True