Medicare/Medicaid
How often will Medicaid cover same or similar items?
Once every 3 years
What is the timeframe to notify the referral source their patient has been taken care of?
5 days
TRUE OR FALSE
Patient does not have to come into location for walk test for POC and original walk test can be used.
FALSE
Patient must retest as the initial walk test is for continuous Oxygen. The POC only dispense pulse dose so we have to test patients to make sure they can use it.
Do we have adequate quantities of Personal Protective Equipment?
PPE Items include Face shield or goggles, gowns, gloves booties, regular masks and N95 mask.
Medicare patient comes into the store having issues with their PAP machine. How do we assist?
Best practice is to try to trouble shoot the issue otherwise swap for brand new machine.
A patient is being ordered a walker but previously got a wheelchair 2 years ago. Is the patient eligible?
No. The patient would have to wait until eligible through the insurance or pay OOP.
Yes, we collect contact info at the time of setup.
Patient calls in needing to order more tanks for a delivery the next day. What steps do we take to assist?
Pull up their account, verify their address, verify their insurance and ask how many empty tanks they currently have.
Why is a HSA (Home Safety Assessment) important?
To identify and review any potential obstacles or hazards within the home.
TRUE OR FALSE
Patient is coming in for a setup but will be changing insurance plans the beginning of the year and was informed his rental will remain the same.
FALSE
If a patient changes insurance during a rental period, the rental period starts all over with the new insurance to meet compliance.
How do we check Medicaid same or similar and when?
We need to check same or similar EVERY time before dispensing DME.
Login to the website and go to prior approval and select DME/O&P History
https://www.nctracks.nc.gov/
How are patient's notified of their financial obligations?
They are to be notified prior to delivery of DME
TRUE OR FALSE
Patient is currently renting a concentrator from us. Their POC from another company is no longer working and they are calling us for assistance. We may help them switch out the POC.
They have to reach out to the company they got the POC from.
What type of education is provided to the patient and where can they find it?
They are educated on how to use the DME in person, help with troubleshooting, Emergency and backup procedures.
All this is located in the Welcome Guide.
Patient came into store stating they have received the wrong supplies when it was shipped. How do we take care of the patient?
We need to make sure supplies is not opened and exchange supplies. When entering the new sales order we must bill quantity 0 all items being exchanged.
Who qualifies for Medicaid?
NC Medicaid provides health care coverage for people with lower incomes.
NC Medicaid provides health care coverage to more people, including people ages 19 through 64. You may be eligible now even if you were not before.
What items might be found in a patient recrods?
Demographic, insurance, physician orders, medical records, Delivery ticket, ABN, AOB, Home Assessment, Plan of care.
When receiving valid walk test or an update walk test for a patient where do we note this information in the patient's account?
We must select the Clinical Tab and then record information in the Oxygen tab.
How do we handle a referral we are not able to process?
We are to notify the referral and patient that we are unable to accept the order and help determine who can accept order.
Patient comes in stating their PAP having a lot of moisture coming through the tubing. How do we assist?
We need to try to trouble shoot. Ask how much water they are putting into the chamber and then adjust the tubing temperature.
A patient comes in with their Medicare card and their Humana Medicare card for us to process a walker order. How do we move forward?
First, we need to explain the difference between the cards.
Humana Medicare Advantage is a replacement for traditional Medicare.
We must process the order under the Humana Medicare Advantage plan, not original Medicare.
How frequently is your plan of care reviewed?
At least every 180 days or more frequently if there is a change in care or services.
Oxygen patients call in asking for extra tanks due to a bad storm that is coming. How do we handle this?
Unfortunately, we do not provide extra tanks and patients are only able to get the same amount they get every week (unless they have had an increase in liter flow). If there is an emergency, they need to call 911
What information is documented in the home assessment?
Environmental Requirements
*Electrical requirements
*Fire and Safety
*Fall risk and assessment
*Emergency Preparedness plan
Patient calls in wanting to order PAP supplies, but they have not received anything from us since 2022. What do we need to be able to help the patient?
We would need an updated prescription and depending on the insurance we may need CUB notes (use & benefit).