CMS Clinical Procedures & Protocols 3

Question 1

A patient admitted to a skilled nursing facility after a 3-day inpatient hospital stay requires daily wound care. Which Medicare benefit covers this stay?

Accepted Answer

Medicare Part A skilled nursing facility benefit

Answer

Medicare Part A covers skilled nursing facility stays when the beneficiary had a qualifying 3-day inpatient hospital admission and requires skilled care.

Question 2

Under Medicare's clinical laboratory fee schedule, which entity typically bills for laboratory services performed in a physician office laboratory (POL)?

Accepted Answer

The physician or group practice that operates the POL

Answer

When a physician's office operates its own laboratory, the physician or group practice bills Medicare directly for those laboratory services.

Question 3

A surgeon performs an appendectomy and during the same operative session discovers and removes an inflamed Meckel's diverticulum. How should the second procedure be reported?

Accepted Answer

Report the additional procedure with Modifier -51 (multiple procedures)

Answer

When multiple procedures are performed during the same operative session, Modifier -51 is appended to the secondary procedure(s) to indicate multiple procedures.

Question 4

Which Medicare clinical protocol governs the maximum frequency of Pap smear coverage for average-risk women?

Accepted Answer

Once every 24 months for average-risk women

Answer

Medicare covers a Pap smear once every 24 months for average-risk women and annually for high-risk women or those of childbearing age with a history of abnormal Pap smears.

Question 5

When a Medicare beneficiary receives chemotherapy in an outpatient hospital setting, which payment system governs reimbursement?

Accepted Answer

Outpatient Prospective Payment System (OPPS)

Answer

Hospital outpatient services including chemotherapy are reimbursed under the Outpatient Prospective Payment System (OPPS), which assigns Ambulatory Payment Classifications.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Clinical Procedures & Protocols 3