Medicare/Medicaid
TRUE OR FALSE
Patient who is wanting to get financial assistance does not have to qualify.
FALSE
Patient not only has to qualify but has to have active insurance.
What qualifies a patient for Group II Oxygen?
Patient is 89% and is diagnosed with Pulmonary Hypertension. Has to visit doctor 61st and 90th day for re-evaluation.
TRUE OR FALSE
All Work Force information is located in the warehouse.
FALSE
It is located in the kitchen.
What is OSA?
Obstructive Sleep Apnea
How often does Medicaid cover Same or Similar items?
Once every 3 years.
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
D. All the above
Failure of both internal and external audits
Overpayments that require refunding
Government Investigations
Sanctions from federal enforcement agencies
Patient has been setup on oxygen at 5lpm and is calling about a wanting a POC. How can we service them?
We can only do walk tests for patient that are 4lpm or less. However, the patient can still do a walk test for a conserving device but not a POC.
If a patient is calling wanting to get the cost of a walker without insurance, where can this be found?
RETAIL PRICING SHEET :)
2 years
TRUE OR FALSE
Patient who got a Transport wheelchair in June is now being ordered a walker. All we need is a prescription and clinical notes.
FALSE.
Patient is not eligible for a walker and would have to pay OOP.
TRUE OR FALSE
With the exception of Medicare, after the first collection attempt management may allow for small balance adjustments under $10.00.
TRUE
How does a patient get tested for Nocturnal Oxygen?
We need a prescription for the patient Oxygen levels to be tested with an ONO on room air or on PAP.
Patient calls in wanting to return their wheelchair they got from our company. How do we take care of them?
First, we need to check to see if it is still renting from us. If it is still renting do a pick ticket to stop billing. However, if it is NOT renting we are then we are not able to take it back as it is now PT owned.
Patient comes into store stating their PAP machine is alarming and needs help. How do we assist?
We should first look into the patients account to see what type of machine it is. Usually, only Vent machines will alarm, and an RT would have to assist
What is an ABN and what is its purpose?
ABN (Advance Beneficiary Notice) An ABN is used only for traditional Medicare patients. It is provided when a patient chooses to pay out‑of‑pocket or when required documentation is missing but the patient still wants us to attempt billing. By signing the ABN, the patient acknowledges that Medicare may deny the claim and that they may be financially responsible for the cost.
Which is an example of prohibited conduct under the Anti-Inducement Statute?
A. Answering questions regarding a patient's financial responsibility for services
B. Providing services for free or below market value to a federal beneficiary
C. Offering payments plans
B. Providing services for free or below market value to a federal beneficiary
Patient is calling to get Oxygen with us but got setup last year with another provider. What do we need to assist?
First, we need to check to see how long they have been with the other provider. If it has been less than a year, then the patient is able to switch to us. Next the patient would need to have all DME picked up by the other company and provide the pick-up ticket. We finally would need a prescription, valid walk test and clinical notes.
If a patient is being ordered a nebulizer machine, what do we need to bill their insurance?
We would need an RX with a J DX code (J44.9) and we would need a list of medications that the patient is to use with the machine along with the frequency.
A BCBS patient comes in wanting to get PAP supplies but has not received anything since 2022. What do we need?
We would need CUB notes and a new RX.
ALL insurances require a new RX once a year for PAP supplies.
What are the 5 parts of Medicare?
Medicare Part A Hospital stay only
Medicare Part B DME coverage
Medicare Part C Medicare advantage
Medicare Part D prescription drug coverage
TRUE OR FALSE
The General Counsel, Chief Compliance Officer and EVP of Sales & Marketing must review and approve all marketing and billing initiatives.
TRUE
What is needed for 5 YR recertification?
*A new SWO (see required elements listed above)
*A new proof of delivery (see required elements listed above)
*A new blood gas study is not required
*RA modifier must be appended to the first month’s rental claim with a narrative explaining the reason for replacement.
How are you supposed to open and close the calls and what is the first this you verify?
Open "Thank you for calling Family Medical supply/Adapthealth. How can I help you?"
Close "Thank you for calling Family Medical supply/Adapthealth. Hope you have a great day."
**Must ALWAYS verify address and insurance info**
TRUE OR FALSE
RePAP patient comes into store not wanting to sit through the class. This patient should be rescheduled for a one-on-one.
FALSE
ANY RePAP patient who comes in and does not want to sit through the class should immediately be setup by the other PAP tech or CSR if not available.