Medicare Flashcards Preview

Ox Test Q > Medicare > Flashcards

Flashcards in Medicare Deck (31)
Loading flashcards...
1

Part A

Hospital insurance

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

2

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%

3

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.

4

Part D

Prescription drug benefits

5

4 regional contractors for processing claims for O and P:

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

6

How many HCFA regional fees schedules:

10 ( do not confusion with 4 DME MAC areas)

7

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

True

8

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

9

Who issues supplier numbers and maintains records?

The national clearing house(NSC)

10

If you elect to become a Participating supplier..

You must accept assignment for all covered Medicare services

11

What is the major advantage of Non-participating suppliers?

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

12

L codes form a subsection of what?

Health care financing administration common procedure coding system (HCPCS)

13

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

14

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

15

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

16

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

17

HOW long must documentation be kept?

10 yrs.

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

All the above

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

All the above

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

C. VOR- The VOR elves as the packing slip

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

All patients

22

Billing or invoicing prior to delivery is permitted

False

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

T

24

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

True

25

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

False

26

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

False

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

False

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

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

FALSE: Soft goods?

29

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

The date the item is shipped out of your office

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

True