Q2: Coding and Documentation

Question 1

Medicare

Answer 1

Federally Funded/Operated

Typically for geriatric and disabled patients

Question 2

Medicaid

Answer 2

State and Federal Programs

Typically for poor patients

Question 3

Riembursment Process

Answer 3

1. Facility must me DMEPOS standards
2. Must obtain/retain Medicare billing privileges
3. Ensure documentation is included and completed correctly

Question 4

Verbal Rx Orders must contain…

Answer 4

1. Item description
2. Beneficiary’s name
3. Physician’s name
4. Date (start of order)

Question 5

Written Rx Orders must contain…

Answer 5

1. Start date
2. All features that will need to be billed seperately
3. Treating physician must review and personally sign/date order

Question 6

Who can sign Rx’s?

Answer 6

• Physicians
• Podiatrists
• NPs
• PAs

Question 7

Delivery Slips methods

Proof of Delivery

Answer 7

• Provider delivers directly to beneficiary/designee
• Provider uses a shipping service to deliver
• Delivery of items to a nursing facility on behalf of a beneficiary

Question 8

Direct Delivery needs to include…

Proof of Delivery

Answer 8

• Beneficiary’s name
• Delivery address
• Description of item
• Quantity
• Date delivered (date recieved)
• Beneficiary signature

Question 9

LCD

Answer 9

“Local Coverage Determination”
-developed by DME MACs

Question 10

What are there LCDs for?

Answer 10

• LL Px
• Ext. Breast Px
• Spinal Ox
• Knee Ox
• AFO/KAFOs
• Orthopedic Footwear
• Theurapeutic shoes for diabetics

Question 11

AFO/KAFO inclusion criteria

LCD Policy

Answer 11

• Rigid/Semirigid
• Used to support weak or deformed body part OR to restrict motion in a diseased or injured body part
• Meet the definition of a brace

Question 12

Orthopedic Footwear inclusion criteria

LCD Policy

Answer 12

• Must be attached to a brace
• Non-coverage for shoes/inserts/mods

Question 13

Therapeutic Shoes inclusion criteria

LCD Policy

Answer 13

• Covered with extensive documentation
• patient has diabetes mellitus
• patient has amp, ulcer, calluses, etc., etc., etc.
• Physcian signing must be managing diabetes and be an MD or DO, and confirm diagnosis, and, and,…….