CMC Funding & Insurance for Mobility Equipment 2

Question 1

Under Medicare Part B, which category covers manual wheelchairs as Durable Medical Equipment (DME)?

Accepted Answer

Part B DME benefit at 80% after deductible

Answer

Medicare Part B covers DME including manual wheelchairs at 80% of the approved amount after the annual deductible is met.

Question 2

What is the primary purpose of a Letter of Medical Necessity (LMN) in the mobility equipment funding process?

Accepted Answer

To document the clinical justification for why specific equipment is medically required

Answer

An LMN documents the clinical basis for the prescribed equipment, linking the patient's diagnosis and functional limitations to the specific item requested.

Question 3

A Medicaid beneficiary in Texas needs a power wheelchair. Which agency administers Medicaid funding decisions for DME in that state?

Accepted Answer

Texas Health and Human Services Commission (HHSC)

Answer

Medicaid is a joint federal-state program administered at the state level; in Texas, HHSC oversees DME coverage decisions.

Question 4

Which funding source is most appropriate for a veteran with a service-connected mobility disability seeking a power wheelchair?

Accepted Answer

Veterans Affairs (VA) Prosthetics & Sensory Aids Service

Answer

The VA Prosthetics & Sensory Aids Service provides mobility equipment to eligible veterans with service-connected disabilities at no cost.

Question 5

What does 'prior authorization' mean in the context of mobility equipment insurance coverage?

Accepted Answer

Approval obtained from the payer before the equipment is dispensed

Answer

Prior authorization is the payer's advance approval that the requested equipment is medically necessary and covered under the beneficiary's plan.

(CMC) Certified Mobility Consultant Practice Test

(CMC) Certified Mobility Consultant Practice Test

CMC Funding & Insurance for Mobility Equipment 2