CO CO Business Operations & Practice Management 2

Question 1

What is the purpose of a prior authorization (PA) in orthotic practice management?

Accepted Answer

To obtain insurer approval before providing a service to confirm coverage and reimbursement

Answer

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?

Accepted Answer

Procedure and product codes for Medicare and Medicaid billing

Answer

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?

Accepted Answer

Patient financial responsibility agreement (financial policy form)

Answer

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?

Accepted Answer

20%

Answer

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?

Accepted Answer

Fraud

Answer

Billing for services or devices not actually provided constitutes healthcare fraud, which is a federal criminal offense.

(CO) Certified Orthotics Specialist Practice Test

(CO) Certified Orthotics Specialist Practice Test

CO CO Business Operations & Practice Management 2