Medicare/Medicaid
Medicare patient comes into store wanting a walker but they got one a year ago. What can we do to service them?
They would have to pay out of pocket or if they have the docs to bill Medicare we can ATTEMPT to bill but they would have to sign an ABN acknowledging that Medicare may not pay for it. If they deny it they are acknowledge they will be responsible for the cost.
Who is our Director of Corporate Compliance?
Patient calls in to order tanks but they are not currently renting portability. How can we assist?
If the patient is not actively renting portability, we would not be able to dispense unless approved by management. We would need a new walk test and prescription for portability.
Who is our Chief Compliance Officer?
Wendy Russalesi
PAP patient's machine has fallen off the bedside table and no longer works. How do we take care of them?
We have to check to see if the machine is still renting and still in warranty. We would then offer the patient a loaner machine while we said the current machine off to be repaired if needed.
Once every 3 years.
In the break room/kitchen area.
What is the difference between a POC and TOC?
TOC - Travel Oxygen Concentrator is a pull behind unit for traveling patients or hospital discharges. Max liter flow is 3lpm.
True or False:
If a Compliance officer asks you a question you are not sure about, you should try to give them your best answer.
FALSE.
If you do not know the answer to a question, do not guess.
How often will BCBS cover supplies?
1. Mask system once every 6 months
2. FFM Cushion once a month; Nasal twice a month
3. Tubing and water chamber once every 6 months
What is same or similar and how often do we check it for Medicare and Medicaid patients?
Same or Similar is how we verify if insurance will cover an item that is being ordered for the patient. We should check this EVERY time a patient gets an order.
What is our Oxygen backup plan?
We supply backup tanks in case of emergencies.
What are the three SATS we need to be able to dispense Oxygen?
Room air at rest
Room air with exertion (88% or lower)
Exertion with Oxygen (recovery SAT has to at least be 90% or higher to be deemed as safe.)
Where can warranty information be found?
The Welcome Guide
Patient is calling in stating the mask is not working for them anymore and they would like to change their mask. What steps would we take to help them?
We would have to check to see when they got the mask. If they were a new setup they have 30 days to do one mask exchange. If after that they are still having issues with the mask it would be an OOP expense (refer to the retail pricing sheet).
If a patient is being ordered an item that we do not have the proper documents for what can we do to assist them?
Patient can choose to wait until the right documents come in or they can sign an ABN acknowledging that if the paperwork does not come in the patient would be responsible for the cost of said item.
What are you suppose to have on your person at all times?
Employee badges
True or False:
Patient was ordered Oxygen only at night. All we need to dispense is a prescription and clinical notes supporting the need.
False
We need an ONO testing showing their O2 levels dropped to 88% or lower.
Do we provide written instructions on how to use the equipment?
Yes, it can be found in our welcome guide. Page 26
Patient new to us is trying to get supplies for their PAP device. What do we need?
We need:
1. itemized prescription
2. Insurance requires CUB (use and benefit) notes
3. Copy of their sleep study
True or False
Medicare patient has a PAP machine that is malfunctioning and it is still renting. We would then be obligated to switch out the unit for a brand new machine.
Inspector comes to office for visit. What are the first steps we take?
Check their badge, have them sign in and make management aware.
If a patient is using a competitor for their Oxygen needs but wants to switch to us, how do we help them?
First, we need to verify how long they have been with the current provider. If they have been with that provider longer than a year we cannot service them.
If it has been less than a year we would need a prescription, walk test and clinical notes supporting the need.
When answering phone calls what do we need to verify with the patient before assisting?
We need the patient to verify their address and make sure their insurance is the same. If it is we need to electronically verify it through our system before moving forward.
What is the compliance usage time frame insurance requires the patients to use the machine to help cover it?
A patient has to use the machine at least 4hrs a day over a 30 day consecutively period any time within the initial 90 days of being setup.