CO CO Business Operations & Practice Management 2 — Questions and Answers
Question 1: What is the purpose of a prior authorization (PA) in orthotic practice management?
- To obtain approval from the state licensing board before treating a patient
- To obtain insurer approval before providing a service to confirm coverage and reimbursement (Correct answer)
- To authorize a technician to fabricate a device
- To pre-approve a patient's therapy referral
Correct answer: To obtain insurer approval before providing a service to confirm coverage and reimbursement
Prior authorization is obtained from the insurance payer before providing services to confirm the device is covered and to secure reimbursement.
Question 2: In orthotic billing, what does the HCPCS code system primarily identify?
- Patient diagnoses
- Procedure and product codes for Medicare and Medicaid billing (Correct answer)
- Physician NPI numbers
- Insurance plan identifiers
Correct answer: Procedure and product codes for Medicare and Medicaid billing
HCPCS (Healthcare Common Procedure Coding System) Level II codes identify specific orthotic and prosthetic products and services for billing purposes.
Question 3: Which document serves as the primary legal agreement between a patient and the orthotic practice regarding financial responsibility?
- Prescription order
- Assignment of Benefits form
- Patient financial responsibility agreement (financial policy form) (Correct answer)
- Certificate of Medical Necessity
Correct answer: Patient financial responsibility agreement (financial policy form)
The patient financial responsibility agreement outlines the patient's obligation to pay for services, including co-pays, deductibles, and non-covered items.
Question 4: What is the standard Medicare coinsurance (patient cost-sharing percentage) for Part B orthotic devices after the deductible is met?
- 10%
- 20% (Correct answer)
- 30%
- 50%
Correct answer: 20%
Medicare Part B requires beneficiaries to pay 20% of the Medicare-approved amount for covered orthotic devices after the annual deductible.
Question 5: Which billing error involves submitting claims for services or devices that were not provided as documented?
- Upcoding
- Unbundling
- Fraud (Correct answer)
- Duplicate billing
Correct answer: Fraud
Billing for services or devices not actually provided constitutes healthcare fraud, which is a federal criminal offense.
Question 6: Under OSHA bloodborne pathogen standards, which item must be readily available at orthotic clinical workstations where exposure to blood or body fluids may occur?
- Sterile surgical gloves
- Personal protective equipment (PPE) including gloves and eye protection (Correct answer)
- Autoclave sterilization equipment
- Biohazard disposal incinerator
Correct answer: Personal protective equipment (PPE) including gloves and eye protection
OSHA requires employers to provide and ensure the use of appropriate PPE, including gloves and eye protection, wherever exposure to bloodborne pathogens is possible.
CO CO Business Operations & Practice Management 2
What is the purpose of a prior authorization (PA) in orthotic practice management?