CO CO Regulatory Compliance & Reimbursement 2

Question 1

The HCPCS L-code L1906 describes which type of orthotic device?

Accepted Answer

AFO, spring wire (dorsiflexion assist calf band)

Answer

Ankle-foot orthosis, posterior solid ankle, custom fabricated

Answer

Knee-ankle-foot orthosis, double upright, custom

Answer

Wrist-hand orthosis, without joints, custom

Question 2

When billing Medicare for a custom-fabricated orthosis, the claim must include documentation that demonstrates which of the following?

Accepted Answer

Medical necessity, a valid prescription, and compliance with applicable LCD criteria

Answer

The patient has private insurance as primary payer

Answer

The device was manufactured outside the United States

Answer

The device cost exceeds $500 retail value

Question 3

A Local Coverage Determination (LCD) for orthotics is issued by:

Accepted Answer

A Medicare Administrative Contractor (MAC) for their jurisdiction

Answer

The American Orthotic and Prosthetic Association (AOPA)

Answer

The Department of Veterans Affairs

Answer

The Joint Commission on Accreditation of Healthcare Organizations

Question 4

Under the Competitive Bidding Acquisition Program (CBAP), which orthotic items are typically excluded from competitive bidding requirements?

Accepted Answer

Custom-fabricated orthoses requiring an individual patient model

Answer

Off-the-shelf prefabricated AFOs

Answer

Standard diabetic shoe insoles

Answer

Prefabricated cervical collars

Question 5

Which organization accredits orthotic and prosthetic facilities and is recognized by CMS for purposes of Medicare supplier accreditation?

Accepted Answer

The Board of Certification/Accreditation (BOC)

Answer

The American Physical Therapy Association (APTA)

Answer

The National Commission on Orthotic and Prosthetic Education (NCOPE)

Answer

The American Occupational Therapy Association (AOTA)

Question 6

Upcoding in orthotic billing — billing for a higher-level device than was actually provided — is prohibited under which federal statute?

Accepted Answer

The False Claims Act (FCA)

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Stark Law (Physician Self-Referral Law)

Answer

The Anti-Kickback Statute (AKS)