DME Overview
What are the 6 DME payment categories ?
A supplier submits the completed _______ form to a Durable Medical Equipment Medicare Administrative Contractor (DME MAC).
What is the CMS 1500 claim form?
If the caller knows the date of service (DOS) for the claim associated with the check, where do you search for the claim.
What is BCC Tier 1 screen All Claims view?
The claim may be denied with an FS or FT action code. This indicates that the claim cannot be paid without a new, revised, or renewed Certificate of Medical Necessity
What is type of denial message may be seen when a CMN is not included with the claim?
Medicare makes 36 rental payments. Supplier maintains ownership of oxygen. Suppliers are responsible for furnishing all the same services during and after the oxygen rental period ends.
What are the coverage guidelines for oxygen?
What does this acronym mean (DMEPOS )?
What is Durable, Medical, Equipment, Prosthetics , Orthotics and Supplies
Which 4 items require a CMN?
If the caller does not know the DOS for the claim associated with the check, how do you research it?
What is use the check’s date to search on the Beneficiaries screen Claims view Checks subview.
On the Claims – VMS screen, scroll down to the Claim History list applet and review the current location and status code of the claim by checking the Location, Status, and Description fields. If the status code in the Status field is not 75, 76, or 77, you can assume that the claim is suspended.
Where should you look in the claim to see if it is suspended?
A ________ does not happen when a beneficiary is an inpatient and uses oxygen continuously during his or her start. This is true no matter the length of the inpatient stay. This is not a break in need because the beneficiary is using oxygen.
What is a break in need?
Hoses, tubes, mouthpieces, ostomy supplies, urological supplies, diabetic supplies, glucose monitoring supplies, dialysis supplies, surgical dressings, intravenous solutions, intravenous therapy supplies, and injection supplies
What are examples of supplies?
Which supplies require a DIF (DME Information Form)?
Which script do you use when a caller wants to determine a check’s status?
What is Beneficiary Checks script?
Capped rental items are durable medical equipment that cost more than $150 and are rented to people who have Medicare. Medicare reduces the allowed amount by_____ starting with the _____ month of rental.
What is 25% and 4th month?
Does the beneficiary using oxygen have a break in need if they are in hospital or other facility?
A break in need does not happen when a beneficiary is an inpatient and uses oxygen continuously during his or her stay. This is true no matter the length of the inpatient stay. This is not a break in need because the beneficiary is using oxygen.
What are the 4 geographic jurisdictions, which are covered by 2 Durable Medical Equipment Medicare Administrative Contractors (DME MACs) ?
The______field explains what happened to a claim. The ______ may indicate that the claim was approved, denied, or duplicated. If the claim was denied, the _____ field briefly explains why the claim was denied.
What is the action field?
Susan Young calls to ask about the status of a check. You complete your research and determine that the status is Void. Ms. Young wants more information about this check. What do you do?
What is Transfer Ms. Young to a Claims Tier 2 CSR.
When a beneficiary is admitted to a hospital or other facility during a capped rental period, their use of the equipment may be interrupted for some time. This is called a “__________” or an “_________” period
What is a “break in service” or an “interruption” period?
Name the oxygen Classification Groups and the Saturation Level for each.
What is Level 1 Less than or equal to 88%
Level 2 Equal to 89%
Level 3 Greater than or equal to 90%
What will be in the QCN (DMERC Only) field if there is not a CMN submitted or on file?
00000000000000
How do you know that a claim has been approved by simply looking in the action field?
When you see SW - N/A in the Action field, it means the claim was approved.
There are several reasons beneficiaries may call to request the status of a check. What is the main reason listed in the participant guide?
Often they call because they believe their check is lost in the mail or possibly stolen.
Medicare pays for repairs only up to the ________or renting another piece of equipment
Medicare pays for repairs only up to the cost of purchasing or renting another piece of equipment
If you can read this you get the $500
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