COC Business Operations & Practice Management 2 — Questions and Answers
Question 1: Which accrediting body provides facility accreditation for O&P practices in the United States?
- ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics) (Correct answer)
- Joint Commission
- URAC
- NCQA
Correct answer: ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics)
ABC provides both individual practitioner certification and facility accreditation for O&P practices, which is required for Medicare supplier enrollment.
Question 2: The Medicare competitive bidding program most directly affects O&P practices by:
- Requiring suppliers in competitive bidding areas to win contracts to supply certain DMEPOS items (Correct answer)
- Mandating specific fabrication techniques for prosthetic devices
- Setting the clinical training requirements for new practitioners
- Controlling the number of patients each practice can accept
Correct answer: Requiring suppliers in competitive bidding areas to win contracts to supply certain DMEPOS items
Competitive bidding requires DMEPOS suppliers in designated markets to bid for contracts to supply covered items at reduced reimbursement rates, affecting practice viability.
Question 3: An O&P practitioner's duty of care to a patient includes which of the following obligations?
- Providing competent care consistent with accepted professional standards (Correct answer)
- Guaranteeing all functional outcomes in writing
- Performing all services at no charge for uninsured patients
- Prescribing only devices manufactured by preferred partners
Correct answer: Providing competent care consistent with accepted professional standards
The duty of care requires practitioners to deliver services that meet the accepted standard of care for the profession, protecting patients from negligent practice.
Question 4: What is the purpose of an advance beneficiary notice (ABN) in Medicare billing for O&P?
- To inform patients that Medicare may not cover a service and obtain their agreement to pay if denied (Correct answer)
- To pre-approve all custom devices before fabrication
- To document functional goals for prosthetic rehabilitation
- To verify the patient's insurance coverage is active
Correct answer: To inform patients that Medicare may not cover a service and obtain their agreement to pay if denied
An ABN notifies Medicare beneficiaries that a service may not be covered, giving them the choice to proceed and accept financial responsibility if Medicare denies the claim.
Question 5: Patient abandonment in O&P practice refers to:
- Terminating care without adequate notice, transition plan, or reason, leaving the patient without needed services (Correct answer)
- Failing to schedule follow-up appointments within 30 days
- Refusing to provide services to new patients
- Discharging a patient when they have met all treatment goals
Correct answer: Terminating care without adequate notice, transition plan, or reason, leaving the patient without needed services
Patient abandonment occurs when a practitioner unilaterally terminates care without proper notification, sufficient cause, or arrangement for alternative services, potentially harming the patient.
Question 6: Documentation in O&P practice must support medical necessity primarily to:
- Substantiate insurance claims and protect against audit findings (Correct answer)
- Satisfy the patient's curiosity about their diagnosis
- Meet publication requirements for case studies
- Fulfill manufacturer warranty documentation requirements
Correct answer: Substantiate insurance claims and protect against audit findings
Thorough documentation of diagnosis, functional limitations, and device justification defends claim integrity during payer audits and protects the practice from recoupment demands.
COC Business Operations & Practice Management 2
Which accrediting body provides facility accreditation for O&P practices in the United States?