CMS Clinical Procedures & Protocols 2

Question 1

Under Medicare guidelines, which condition must be documented before a physician can order home health skilled nursing visits?

Accepted Answer

Patient must be homebound and require skilled care on an intermittent basis

Answer

Medicare home health eligibility requires the patient to be homebound and need skilled nursing or therapy on an intermittent basis.

Question 2

A Medicare patient undergoes a colonoscopy and a polyp is removed during the same session. How is this typically billed?

Accepted Answer

The polyp removal is billed separately using a surgical code

Answer

When a therapeutic intervention such as polyp removal occurs during a diagnostic colonoscopy, the surgical procedure code replaces the diagnostic code and is billed separately.

Question 3

Which Medicare part covers outpatient physical therapy services provided in a hospital outpatient department?

Accepted Answer

Medicare Part B

Answer

Medicare Part B covers outpatient therapy services including physical, occupational, and speech-language therapy provided in hospital outpatient settings.

Question 4

A CMS specialist reviews a claim where a physician performed wound debridement using selective technique. What is the most critical documentation element to support medical necessity?

Accepted Answer

Wound size, depth, type of tissue removed, and clinical response

Answer

Wound debridement claims require detailed documentation of wound characteristics, tissue type removed, and clinical response to justify medical necessity.

Question 5

Under the Medicare Physician Fee Schedule, what does the term 'global surgery period' refer to?

Accepted Answer

The period during which all related pre- and post-operative services are included in the surgical fee

Answer

The global surgery period bundles pre-operative, intraoperative, and post-operative services into one payment for a defined period (0, 10, or 90 days).

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Clinical Procedures & Protocols 2