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

Medicare requires claims to be filed within 1 calendar year (12 months) from the date of service to be considered for payment.

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

Accepting assignment means the provider agrees to accept the Medicare-approved amount as payment in full and cannot bill the beneficiary more than the applicable coinsurance or deductible.

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

Medicare Part B typically pays 80% of the approved amount for covered O&P items after the annual deductible is met, with the beneficiary responsible for the remaining 20% coinsurance.

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

A CMN is a physician-signed document that certifies a prescribed item meets medical necessity criteria, often required by Medicare for specific categories of DME and O&P devices.

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

Medicare defines medically necessary services as those that are reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member.

COC - Certified Orthotic and Prosthetic Practitioner Practice Test

COC - Certified Orthotic and Prosthetic Practitioner Practice Test

COC Coding, Billing & Reimbursement 2