Medicare/Medicaid
A patient would have to pay OOP for the walker but they have to sign an ABN explaining why they are paying OOP.
True or False:
AdaptHealth does not protect employees who report suspected noncompliance from retaliation or retribution.
False.
Patient calls in to order more tanks but there is nothing renting in their account. What are need to be taken to take care of the patient?
The patient would need all new documents before dispensing anything O2 related unless approved by management. (RX, Valid walk test and clinical notes)
O2 is regulated by the FDA.
True or False
The AdaptHealth Corporate Compliance Program includes compliance policies, training, audit and monitoring, internal investigations, and corrective actions.
True
Patient was ordered a nasal mask with their UHC insurance. How much supplies can they receive?
They can get up to 3 months worth of supplies at a time.
We receive an order for a patient to get a walker. What do the clinical notes need to say?
*patient has a mobility limitation that significantly impairs their ability to participate in one or more daily activities
*patient is able to safely use walker
*the functional mobility deficit can be resolved by walker
Which of the following are mechanisms used to report suspected noncompliance?
A. Make a report to a manager or supervisor
B. Make a report to any member of the Compliance Committee
C. Make a report to any member of the Corporate Compliance Dept
D. Make a report to AdaptHealth hotline
F. All the Above
F. All the Above
An order came over indicating a patient's room air SAT was 89%. Are we able to assist them?
Yes. Based on that room air SAT they qualify for "Short Term," Oxygen and would have to repeat the testing between their 61st and 90th day of starting O2.
Which of the following is prohibited by the Anti-Trust Statute?
A. Dealing fairly and openly with customers and suppliers
B. Enforcing of contractual obligations
C. Using Coercive practices or threatening customers
C. C. Using Coercive practices or threatening customers
True or False:
A patient who does not meet their compliance within the first 30 days has to turn in the machine.
False. They have 90 days to meet their compliance.
How often should we check with Medicaid patients that the ordering provider is PECOS certified?
Representatives from CMS need to be directed to:
A. Director of Operations
B. Audit Service Manager
C. Chief Compliance office
D Pharmacist
C. Chief Compliance office
Patient calls in for a POC but state they are not able to walk for the walk test. How do we assist?
The testing does not have to be a walking test. As long as we are able to test their exertion levels.
They can raise and lower their arms or transfer from one chair to another.
True or False:
Confidential information can be openly shared with others outside of AdaptHealth.
False!
A repap patient comes in to do a mask exchange and their prescription says mask of patient's choice. What steps do to do to take help the patient?
RePAP patients are not eligible for a mask exchange and would have to wait until they are eligible through insurance to get a new one.
OR They can pay OOP
If a patient is trying to get hospital bed accessories but they did not get their bed from us, are we able to service them?
Yes. As long as it still went through insurance we can bill for accessories.
Are all Covered Persons responsible for maintaining compliance with federal regulations and AdaptHealth’s Compliance Program?
Yes
We cannot. The patient is only able to bill one portable system at a time to the insurance. The only time they can get a tank or two is if that is their backup system for emergencies.
Where can TB information be located in the store?
In the Kitchen area.
A referral calls into the store asking for us to link them to the mutual patient's PAP compliance report in AirView. Are we able to do this?
Yes. We would need the patient's information and the doctor's information.
Patient is being ordered a Shower chair and they have UHC with Medicaid as a secondary. Are we able to bill?
Yes. As long as Medicaid is listed as a secondary, we would be able to dispense, but we need to check the "Bill for Denial" tab.
Questions regarding records retention and destruction should be directed to:
A. Chief Compliance Officer
B. District Sale Manager or Intake Manager
C. Billing Manager
D. Human Resources
A. Chief Compliance Officer
An order is received for an existing patient who is currently on 2LPM to increase to 6LPM. How do we take care of the patient?
We will need to call and inform the patient of the increase. Put in an exchange ticket in their account to provide the 10Liter concentrator and ticket up the 5Liter.
Which of the following is a violation of the False Claims Act:
A. Knowingly filing a claim for services that were not rendered
B. Filing a claim with all required documentation to establish medical necessity
C. Requesting updated chart notes from a practitioner
D. Contacting the patient's prescriber to ensure the accuracy of the prescription
A. Knowingly filing a claim for services that were not rendered
An established patient who got a PAP machine in March is now being ordered a BiPAP. Are they able to switch is their PAP is still renting?
Yes. The patient usually had another sleep study indicating that the PAP was not working and found that the BiPAP did. Patient would bring PAP machine back in order to get the BiPAP.