Medicare/Medicaid
Medicare patient comes in with a PAP machine that is not working. What do we do to help?
We need to check to see if the machine is still renting, and if it is we switch it out for a brand-new machine.
If the machine is NOT renting, the patient would have to pay OOP to rent a machine while we send the machine off.
What insurance covers Knee walkers?
BCBS, Tricare and Medicaid.
Patient is calling to order tanks. What steps do we take to assist?
Verify all their information, verify that they are actively renting Oxygen from us and confirm how many empty tanks they have to exchange. Set delivery for NEXT DAY.
Patient comes to store wanting to return tanks. What do we do?
Have patient sign a pickup ticket with an AMA if wanting to return altogether. Bring returned tanks to kitchen area and put in the dirty pile. Make sure no green tabs are on tanks and take all cannulas along with regulators off tanks.
How often do we check to see if a patient's RX is valid?
EVERYTIME they either call or come into store for supplies.
RX only good for 1 yr
There is an order for a hospital for a patient to get a hospital bed through Medicare. However, we do not have the qualifying notes per Medicare guidelines. What do we do?
We need to make the referral know what verbiage is needed and make the patient aware to, while also encouraging them to speak with the referral as well.
If patient does not want to wait, they can sign an ABN to try to bill Medicare stating they are aware we do not have what we need.
Patient is calling in stating that their doctor states they need a gel overlay for their hospital bed. What is the first thing we ask?
We need to ask if they are wanting to go through insurance or pay OOP.
If they want to it to go through insurance, we need a prescription as it is an accessory to the wheelchair.
How often is a patient supposed to change their nasal cannulas?
Every 2 weeks.
Unless the patient has an upper respiratory infection, in that case they need to change it immediately.
Where can our TB be found?
Displayed in the kitchen area.
New PAP patient comes in wanting to buy a mask OOP. Are we able to service them?
We would have to have a prescription to be able to dispense the supplies.
Where can Medicare Same or Similar be checked?
https://mycgsportal.com/MyCGS/CGSAccount/Login
MYCGS Website
TURE OR FALSE
A patient can get a cushion for a wheelchair without a prescription.
FALSE
Anything going through insurance REQUIRES a prescription. A cushion is an accessory and requires a prescription and notes.
A patient calls in wanting to know how often they are supposed to change their humidifier bottle.
What is the correct answer?
Once a month usually.
True or False:
We are allowed to sign documents for physicians and patients if requested.
FALSE.
DEEEEEEENIED
How do we determine the OOP price of a FFM?
Retail pricing sheet
$135
Medicare patient comes in stating that they were informed that Medicare will pay for a shower chair. How do we process this?
A shower chair is not a billable item for us to process through Medicare as Medicaid it the ONLY insurance that will cover bathroom items.
However, we can TRY to bill through Medicare with an ABN.
How do we determine the size of a wheelchair that would be best suitable for?
It goes by height and weight.
We can use the wheelchair size chart.
What is the MAX liter flow we assist patients with?
15LPM
Where can the patient right info be found?
Welcome Guide
True or False:
Patients account shows they have an APAP machine which can only be serviced by an RT.
False.
APAP is a PAP machine that can function as both a CPAP and a BiPap.
Billing Medicare without proper documentation may result in which of the following?
A. Failure of both internal and external audits
B. Overpayments that require refunding
C. Government Investigations
D. Sanctions from federal enforcement agencies
E. All the above
E. ALL THE ABOVE.
We are required to have all the docs prior to attempting to bill, unless we have an ABN on file.
Patient calls in with asking questions about hospital bed and wanting to know why the bed has to rent. What would be the best way to explain this?
We would need to let them know this equipment is a rent to own.
Most insurances will rent the equipment for 12 months and if at any point during the rental period it is no longer need it, then it can be returned. If it is needed past the 12 months
Patient of ours who is on 2lpm is needing to travel to a different state and needs portable Oxygen. How do we help?
We are able to provide them with a TOC free of charge.
(Always have to check the TOC book for availability)
Who is the CEO of AdaptHealth?
Suzanne Foster.
How often is a new prescription needed for PAP supplies?
Once a year.
BCBS requires an RX and CUB notes yearly.