CO CO Regulatory Compliance & Reimbursement

Question 1

Which federal program sets the L-code system used to classify and bill orthotic devices in the United States?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Joint Commission (TJC)

Answer

The American Board for Certification in Orthotics (ABC)

Answer

The Food and Drug Administration (FDA)

Question 2

Under Medicare policy, which documentation is required from the referring physician before a custom orthosis is considered medically necessary and reimbursable?

Accepted Answer

A written order or prescription specifying the orthotic need

Answer

A signed insurance pre-authorization form only

Answer

A completed ABC certification form

Answer

A physical therapy evaluation summary

Question 3

The ABC (American Board for Certification) credential for an orthotist is designated as:

Accepted Answer

CO (Certified Orthotist)

Answer

RO (Registered Orthotist)

Answer

LO (Licensed Orthotist)

Answer

BOC-O (Board Certified Orthotist)

Question 4

A Certificate of Medical Necessity (CMN) for a spinal orthosis under Medicare must be signed by:

Accepted Answer

The treating physician or eligible non-physician practitioner

Answer

The certified orthotist who fabricated the device

Answer

The patient or their legal guardian

Answer

The insurance carrier's medical director

Question 5

Under HIPAA regulations, a patient's orthotic records may be shared with a new treating physician without additional written authorization because this falls under:

Accepted Answer

Treatment, payment, and health care operations (TPO)

Answer

Marketing and fundraising activities

Answer

Research purposes with IRB waiver

Answer

Public health reporting requirements

Question 6

Which federal law requires orthotic practices to maintain an Advance Beneficiary Notice (ABN) process for Medicare patients when the service may not be covered?

Accepted Answer

The Social Security Act Section 1862

Answer

The Americans with Disabilities Act (ADA)

Answer

The Rehabilitation Act of 1973

Answer

OSHA regulations