COF Insurance & Reimbursement 2

Question 1

Which Medicare benefit covers custom orthotics for a diabetic patient with peripheral neuropathy?

Accepted Answer

Medicare Part B

Answer

Medicare Part B covers durable medical equipment including custom orthotics when medically necessary.

Question 2

What is the purpose of an Advance Beneficiary Notice (ABN) in Medicare billing?

Accepted Answer

To inform the patient that Medicare may not cover the item so they can decide whether to proceed

Answer

An ABN notifies a Medicare beneficiary that a service may not be covered so they can choose to receive it and pay out-of-pocket if denied.

Question 3

Under Medicare, which HCPCS code range primarily covers orthotic devices?

Accepted Answer

L-codes (L0000–L4999)

Answer

L-codes are the HCPCS Level II codes specifically designated for orthotic and prosthetic devices.

Question 4

A claim is denied with remark code CO-57. What does this typically indicate?

Accepted Answer

The claim was filed after the timely filing deadline

Answer

CO-57 (or similar timely filing denials) indicates the claim was submitted after the payer's deadline for filing.

Question 5

What does 'coordination of benefits' (COB) mean in the context of orthotic billing?

Accepted Answer

Determining which payer pays first and how secondary insurance covers remaining costs

Answer

COB is the process of determining the order of payment when a patient has more than one insurance plan to prevent duplicate payments.

(COF) Certified Orthotic Fitter Practice Test