CMC Medicare & Medicaid Funding 2

Question 1

Under Medicare Part B, which documentation is required from the treating physician before a power wheelchair can be approved?

Accepted Answer

A written order and face-to-face examination within 6 months of the order

Answer

Medicare requires a written order and a face-to-face examination by the treating physician within 6 months prior to the order for complex power wheelchairs.

Question 2

A beneficiary needs a power operated vehicle (scooter) but also qualifies for a power wheelchair. Medicare will typically fund whichever device:

Accepted Answer

Is least costly that still meets the beneficiary's medical needs

Answer

Medicare uses the least costly alternative principle, covering the least expensive device that adequately meets the beneficiary's medical needs.

Question 3

Under the Medicare Durable Medical Equipment competitive bidding program, beneficiaries in contract areas must obtain complex power wheelchairs from:

Accepted Answer

Only suppliers that won a competitive bidding contract for that area

Answer

In competitive bidding areas, Medicare beneficiaries must use contract suppliers for covered DME items or risk denial of claims.

Question 4

Which Medicare coverage group classification applies to a power wheelchair with power seat elevation and power tilt features?

Accepted Answer

Group 3 Complex Rehabilitative Power Wheelchair

Answer

Power wheelchairs with power seat elevation and power tilt are classified as Group 3 Complex Rehabilitative Power Wheelchairs under the Medicare coding system.

Question 5

A Medicaid recipient's wheelchair claim is denied because the device is deemed 'not medically necessary.' The FIRST step in the appeals process is typically:

Accepted Answer

Submitting a redetermination or internal appeal to the Medicaid agency

Answer

Most state Medicaid programs require an internal redetermination or reconsideration before a beneficiary can request a formal fair hearing.

(CMC) Certified Mobility Consultant Practice Test

(CMC) Certified Mobility Consultant Practice Test

CMC Medicare & Medicaid Funding 2