CO CO Regulatory Compliance & Reimbursement 1

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

CMS establishes and maintains the HCPCS Level II L-code billing system used to classify and reimburse orthotic and prosthetic devices under Medicare and Medicaid.

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

Medicare requires a written order or prescription from a physician or eligible non-physician practitioner that specifies the orthotic device needed before the claim is considered for reimbursement.

Question 3

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

Accepted Answer

CO (Certified Orthotist)

Answer

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics awards the CO (Certified Orthotist) credential to practitioners who pass the required written and patient management examinations.

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

A CMN must be completed and signed by the treating physician or eligible non-physician practitioner, not the orthotist, to validate the medical necessity of the device for Medicare reimbursement.

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

HIPAA's Privacy Rule permits disclosure of protected health information (PHI) for treatment, payment, and health care operations without additional patient authorization.

(CO) Certified Orthotics Specialist Practice Test

(CO) Certified Orthotics Specialist Practice Test

CO CO Regulatory Compliance & Reimbursement 1