COC Coding, Billing & Reimbursement 2

Question 1

What is the standard timely filing deadline for submitting Medicare Part B claims?

Accepted Answer

1 calendar year from date of service

Answer

90 days from date of service

Answer

6 months from date of service

Answer

2 years from date of service

Question 2

In Medicare O&P billing, what does it mean for a provider to accept 'assignment'?

Accepted Answer

Agreement by the provider to accept Medicare's approved amount as full payment

Answer

The process of assigning HCPCS codes to specific devices

Answer

The transfer of a patient's benefits to a different provider

Answer

Mandatory enrollment in the Medicare program

Question 3

After the annual deductible is met, what percentage of the Medicare-approved amount does Medicare Part B typically pay for covered O&P items?

Accepted Answer

80%

Answer

100%

Answer

70%

Answer

90%

Question 4

What is the primary function of a Certificate of Medical Necessity (CMN) in O&P practice?

Accepted Answer

To certify that a prescribed item is medically necessary for a specific patient

Answer

To document the patient's current diagnosis codes

Answer

To verify a provider's professional licensure status

Answer

To authorize payment coordination with a secondary insurer

Question 5

How does Medicare define 'medical necessity' for O&P items and services?

Accepted Answer

Services or items that are reasonable and necessary for the diagnosis or treatment of illness or injury

Answer

Any device that a licensed physician prescribes for a patient

Answer

Devices that demonstrably improve a patient's quality of life

Answer

Items that represent the least expensive clinically appropriate option

Question 6

Which of the following is a fundamental documentation requirement for most Medicare O&P claims?

Accepted Answer

A detailed written order or prescription from the treating physician

Answer

A photocopy of the patient's insurance card

Answer

A competitor price comparison for the device provided

Answer

A completed patient satisfaction survey

Question 7

What is a 'Medicare crossover claim'?

Accepted Answer

A claim automatically forwarded from Medicare to a secondary insurer after Medicare processes its portion

Answer

A claim submitted simultaneously to both Medicare Part A and Part B

Answer

A claim submitted by two different providers for the same patient on the same date

Answer

A claim that spans multiple dates of service across two calendar years