COC Business Operations & Practice Management 1 — Questions and Answers
Question 1: Which federal act establishes the foundation for protection against discrimination for patients with disabilities seeking O&P services?
- Americans with Disabilities Act (ADA) (Correct answer)
- Health Insurance Portability and Accountability Act (HIPAA)
- Affordable Care Act (ACA)
- Social Security Act
Correct answer: Americans with Disabilities Act (ADA)
The ADA prohibits discrimination against individuals with disabilities in public accommodations, employment, and services, directly affecting how O&P practices must serve all patients.
Question 2: The ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics) requires practitioners to earn continuing education units (CEUs) to:
- Maintain board certification and ensure ongoing competency (Correct answer)
- Qualify for Medicare billing privileges only
- Meet state licensure requirements exclusively
- Obtain malpractice insurance coverage
Correct answer: Maintain board certification and ensure ongoing competency
ABC certification renewal requires CEUs to ensure practitioners stay current with evolving clinical evidence, technology, and practice standards.
Question 3: Prior authorization for a prosthetic device from Medicare is required primarily to:
- Verify medical necessity and ensure reimbursement eligibility before fabrication (Correct answer)
- Set the retail price of the device for the patient
- Determine which manufacturer the practitioner must use
- Approve the color and cosmetic finish of the device
Correct answer: Verify medical necessity and ensure reimbursement eligibility before fabrication
Prior authorization confirms that the prescribed device meets Medicare's medical necessity criteria, protecting both the patient and the provider from claim denials.
Question 4: Which document must be obtained from the prescribing physician before an orthosis or prosthesis can be billed to Medicare?
- Written order or prescription (Certificate of Medical Necessity) (Correct answer)
- Patient satisfaction survey
- Insurance pre-qualification form only
- Lab results from the hospital
Correct answer: Written order or prescription (Certificate of Medical Necessity)
A written prescription or Certificate of Medical Necessity (CMN) from the treating physician is required by Medicare before an O&P device can be billed.
Question 5: HIPAA regulations in an O&P practice primarily govern:
- Protection and confidential handling of patient health information (PHI) (Correct answer)
- Billing codes for prosthetic devices
- Employee wage and hour requirements
- Marketing and advertising of O&P services
Correct answer: Protection and confidential handling of patient health information (PHI)
HIPAA establishes standards for safeguarding protected health information (PHI), requiring O&P practices to control access to and use of patient medical records.
Question 6: In O&P practice, the 'ABC Scope of Practice' defines:
- The range of services and devices an ABC-certified practitioner is competent to provide (Correct answer)
- The maximum number of patients a practitioner can treat per day
- The geographic area in which a practitioner may operate
- The financial limits on device costs for Medicare billing
Correct answer: The range of services and devices an ABC-certified practitioner is competent to provide
The ABC Scope of Practice outlines the clinical services and device categories within the competency boundaries of certified orthotists, prosthetists, and pedorthists.
COC Business Operations & Practice Management 1
Which federal act establishes the foundation for protection against discrimination for patients with disabilities seeking O&P services?