SMS Funding and Documentation

Question 1

Under Medicare, which category covers manual and power wheelchairs as Durable Medical Equipment?

Accepted Answer

Part B

Answer

Part A

Answer

Part C (Medicare Advantage only)

Answer

Part D

Question 2

What is a Letter of Medical Necessity (LMN) in the context of seating and mobility funding?

Accepted Answer

A clinician-authored document that explains why a specific device is medically required for the patient

Answer

A note from the insurance case manager approving the device

Answer

A form completed by the equipment supplier listing device costs

Answer

A Medicare-required form for all DME orders

Question 3

Which of the following is required documentation for Medicare to cover a power wheelchair?

Accepted Answer

A face-to-face examination by the treating physician or NPP within 6 months prior to the written order

Answer

A home assessment completed by the supplier

Answer

A trial period of at least 30 days in a standard wheelchair

Answer

Physical therapy discharge summary

Question 4

The term 'prior authorization' in wheelchair funding refers to:

Accepted Answer

Payer approval obtained before the device is provided, to confirm coverage

Answer

Approval from the physician before the therapist evaluates the patient

Answer

Manufacturer approval for custom modifications

Answer

State Medicaid pre-certification of the supplier

Question 5

A 'K-level' classification in lower extremity prosthetics is analogous to which concept in wheelchair funding?

Accepted Answer

Functional level matching device capability to patient ability

Answer

HCPCS code

Answer

Coverage determination letter

Answer

CMS competitive bidding area

Question 6

When a Medicare claim for a power wheelchair is denied, the first level of appeal is called:

Accepted Answer

Redetermination by the Medicare Administrative Contractor (MAC)

Answer

Administrative Law Judge (ALJ) hearing

Answer

Qualified Independent Contractor (QIC) redetermination

Answer

Office of Medicare Hearings and Appeals (OMHA)