CMC Medicare & Medicaid Funding 5

Question 1

A Medicare Advantage (Part C) plan is required to cover mobility equipment:

Accepted Answer

At least to the same extent as Original Medicare Part B

Answer

Medicare Advantage plans must cover all services that Original Medicare covers, including DME such as mobility equipment, at a minimum under the same criteria.

Question 2

Which condition would make a beneficiary INELIGIBLE for Medicare Part B coverage of a power wheelchair?

Accepted Answer

The beneficiary requires the chair only outside the home for community mobility

Answer

Medicare Part B only covers power wheelchairs for use within the home; a device needed solely for community or outdoor use does not meet the 'in the home' coverage requirement.

Question 3

An Assistive Technology Professional (ATP) performing a seating evaluation for Medicare documentation purposes must hold a certification from which recognized body?

Accepted Answer

The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)

Answer

Medicare requires that the ATP performing the seating evaluation hold RESNA certification to qualify the evaluation for complex rehabilitative power wheelchair claims.

Question 4

Under Medicaid managed care, a managed care organization (MCO) denies a power wheelchair for a member. The member's right to a state fair hearing:

Accepted Answer

Is preserved and available after exhausting the MCO's internal appeals

Answer

Even in Medicaid managed care, members retain the right to a state fair hearing after exhausting the MCO's internal grievance and appeal process.

Question 5

A CMC is advising a client whose Medicare-funded power wheelchair needs a new seating system after three years due to a change in the client's condition. The funding pathway for this replacement seating is:

Accepted Answer

Requires a new prescription and clinical documentation supporting the change in need

Answer

Replacement of seating components due to a change in medical condition requires updated clinical documentation and a new physician order demonstrating the new need.

(CMC) Certified Mobility Consultant Practice Test

(CMC) Certified Mobility Consultant Practice Test

CMC Medicare & Medicaid Funding 5