Medicare Flashcards
Part A
Hospital insurance
Helps pay for inpatient hospital, skilled nursing, and hospice at no charge to beneficiaries
Part B
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%
Part C
HMO (advantage plans) beneficiary signs over their benefits to a privately managed HMO. O&P providers must obtain a pre-authorization to provide services.
Part D
Prescription drug benefits
4 regional contractors for processing claims for O and P:
DME MACs- durable medical equipment Medicare administrative contractors
Jurisdictions A,B,C,D
How many HCFA regional fees schedules:
10 ( do not confusion with 4 DME MAC areas)
T or F: routine waiver of deductible and co-insurance by suppliers is unlawful
True
What does assignment mean?
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
Who issues supplier numbers and maintains records?
The national clearing house(NSC)
If you elect to become a Participating supplier..
You must accept assignment for all covered Medicare services
What is the major advantage of Non-participating suppliers?
You decide weather to accept assignment on a claim by claim basis
L codes form a subsection of what?
Health care financing administration common procedure coding system (HCPCS)
REQUIRED documentation
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
Requirements for written orders
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
Advanced beneficiary notice:
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
Proof of delivery
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
HOW long must documentation be kept?
10 yrs.
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
All the above
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
All the above
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
C. VOR- The VOR elves as the packing slip
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
All patients
Billing or invoicing prior to delivery is permitted
False
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
T
The VOR must include the quantity and description of each procedure code provided/billed
True
In case when a patients is unable to sign and date the VOR, Hanger staff may act as the patients qualified representative
False
T or F the date of service must always agree with the date of delivery
False
T or F: on an unassigned claim, you may not collect more than 20% of the Medicare fee schedule amount and the Medicare deductible
False
provider does not submit paperwork, patient is responsible for submitting paperwork
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
FALSE: Soft goods?
When shipping items to a patient what is the date of service
The date the item is shipped out of your office
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
True
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
True
