COMPLIANCE
During business hours, suppliers may NOT exclusively use these kinds of phones.
What are beepers, answering machines, answering services, or cell phones?
Before any repair is initiated, this must always be verified to determine whether the item is eligible for service under the supplier.
checking the warranty or ownership status
A concentrator that won’t turn on usually indicates an issue with one of these two components.
the power outlet or the power cord
Medicare will not pay for an item if the physician’s documentation does not support this essential requirement.
What is medical necessity?
This item must be verified to ensure the patient’s benefits are active prior to equipment delivery.
What is insurance eligibility?
A physical facility must be at least this many square feet.
What is 200 square feet?
These two pieces of information must ALWAYS be documented at the time a patient requests a repair for a cpap
What are the serial number and description of the problem
Medicare requires that qualifying blood gas or oximetry testing be performed at this specific point in the patient’s illness, when oxygen is expected to improve their condition
the “time of need” — during the illness or within 2 days before hospital discharge
This program requires DME suppliers to meet strict quality and accreditation standards to bill Medicare.
What is the Medicare Supplier Standards Program?
This document is required to confirm who is legally responsible for payment if the patient is unable to sign.
What is a power of attorney or responsible party form?
Suppliers must be open to the public for a minimum of this many hours per week.
What is 30 hours per week?
This inventory status refers to equipment that is fully cleaned, tested, and ready to be delivered again.
What is patient‑ready or refurbished?
To qualify a patient for ambulatory oxygen, Medicare requires three specific exercise‑related oxygen tests completed in the same session. Name one of these required tests.
Resting (off oxygen), Exercising (off oxygen), or Exercising (on oxygen)
Medicare covers DME under this portion of the program, which handles outpatient services.
What is Medicare Part B?
Before setting up equipment, staff must check the environment for hazards like cords or clutter, known as this.
What is a home safety assessment?
Suppliers must answer these promptly and document the interaction.
What are beneficiary questions and complaints?
This patient detail must match exactly on the order and insurance card for clean processing.
What is the patient’s name and date of birth?
OSA patients cannot qualify for oxygen from home oximetry alone. What specific type of sleep study is required?
titrated, facility‑based polysomnogram (PSG)
Medicare’s national DME rules are published by this organization under CMS.
What is the DME MAC (Durable Medical Equipment Medicare Administrative Contractor)?
Oxygen equipment must be kept away from this common household item for safety.
What is an open flame?
This term describes billing Medicaid for an upgraded or more expensive item when the patient received a basic one.
What is upcoding or unbundling (depending on scenario)?
Billing for equipment not actually delivered is considered this serious offense.
What is fraud?
Medicare requires that nocturnal desaturation must persist even after PAP is optimized in order to classify this condition for oxygen coverage.
true residual nocturnal hypoxemia despite effective PAP therapy
To qualify as Durable Medical Equipment, an item must be able to withstand repeated use and last for at least this long.
What is 3 years?
If a supplier delivers equipment without this required prior step--needed for certain DME items like hospital beds or wheelchairs-- they risk non payment or claim denial
What is prior authorization?