Medicare Basics I

1.

5 points

What does LCD stand for?

Local Clean Drive

Limited Coverage Deal

Lofty Coverage Deal

Local Coverage Determination

2.

5 points

What does AHI stand for?

Apneic Hypo Index

Apnea Hypopneic Index

Apneic Hyper Index

Apnea Hypopnea Index

3.

5 points

What does RDI stand for?

Rationale Distinction Index

Respiratory Divide Index

Respiration Distinction Index

Respiratory Disturbance Index

4.

5 points

What is a RERA?

Respiratory Effort Rated Arousal

Random Earnest Rated Answer

Respiratory Effort Related Arousal

Real Ethical Rated Answer

5.

5 points

RERAS are accepted by Medicare.

True

False

6.

5 points

What is the minimum qualifying number for AHI/RDI?

10

4

5

15

7.

5 points

On a sleep study, there are many AHI's mentioned. Which one should be reviewed?

The supine AHI

The REM AHI

The AHI during Total Sleep Time

The AHI during Total Recording Time

8.

5 points

What is a Type I study?

It is a study that is performed at home

It is a study that is done over a few days

It is facility based (in a hospital or sleep lab)

It is when a specialized sleep doctor reviews your sleep test

9.

5 points

What does HST stand for and what is it?

Hyper System Test - This reviews respiratory events while awake

Home Style Testing - The doctor visits the patient at home to apply the testing device

High System Test - This checks for the highest level of occuring respiratory events

Home Sleep Test - it is a sleep test that is applied and performed by the patient at home

10.

5 points

What additional requirement is needed for an HST?

Patient has to bring in test results for physician review

Documentation of instructions given to patient on how to use and apply the device

Patient has to pay an extra fee for the test results

After an HST, patient will have to take another test

11.

5 points

How long can a PAP device be rented?

13 months, then it's patient owned

It is continuously rented

10 months, then it's patient owned

3 months, then it's patient owned

12.

5 points

What is the primary diagnosis for CPAP users?

Obstructive Sleep Apnea

Hypertension

Daytime sleepiness

Central Sleep Apnea

13.

5 points

The interpreting physician for a sleep study must meet sleep credentialing requirements:

If the study was performed on or after 11/1/08

If the study was performed on or after 1/1/10

Whenever there is a in lab sleep study

Whenever there is a home sleep test

14.

5 points

The CMN on file states "E0601: Initial DOS: 1/1/16, LON: 13 Months, This item was purchased." What does this tell you?

The E0601 was purchased and the patient is not eligible for a unit until 1/1/17

Patient is only eligible for a different type of unit that is not E0601.

Patient is eligible for supplies only.

The CMN on file is for supplies only. Patient is eligible for any unit.

15.

5 points

The CMN on file states "E0601: Revised date: 1/10/14, Initial DOS: 1/1/14, LON: 13 Months, Last billed date: 1/1/15." What date do we look at to calculate when the patient is eligible for a replacement unit and is this patient eligible?

1/10/14; No, not until 1/1/19

1/10/14; Yes, eligible now

1/1/14; No, not until 1/1/19

1/1/14; Yes, eligible now

16.

5 points

How often does Medicare allow a replacement for CPAP or BIPAP?

Every 3 years

Every 5 years

Every 13 months

Anytime the doctor thinks it's medically necessary

17.

5 points

The CMN on file states "E0601: Initial DOS: 1/1/14, LON: 13 Months, Last billed date: 1/1/15." The doctor prescribed an E0470. Is the patient eligible for an E0470 today?

No, patient has to wait until 1/1/19.

Yes, it is a different billing code but the patient needs to return the CPAP.

Yes the patient is eligible and does not need to return the CPAP.

No, the patient is only eligible for CPAP.

18.

5 points

The CMN on file states: E0601: Initial date 1/1/12, LON: 13 months, 281-222-2120 Last billed date: 6/1/12, 6 months paid. The patient received the E0601 from another DME. The doctor is prescribing a new E0601. Is the patient eligible?

No, the patient is not eligible until 5 years from 1/1/12.

Maybe. The CPAP did not cap out at 13 months. Need to change checklist to Transfer PAP.

Yes, the patient is eligible now.

The patient is only eligible for an E0470.

19.

5 points

An E0470 can be reviewed for either OSA or non OSA diagnosis.

True

False

20.

5 points

A prescription is marked for E0470 with a diagnosis of COPD. There are office notes but no sleep study. I will continue to review for E0470 under OSA. According to OSA guidelines, the patient is not eligible for an E0470.

True, the patient is currently not eligible for an E0470 because we do not have the sleep study.

False, the patient should not be reviewed under OSA if the doctor marked COPD diagnosis. We should review under the COPD diagnosis.

True, the patient is not eligible for E0470 under the OSA and COPD diagnosis.

False, we should review under COPD and should deny asking for the sleep study.