Medicare Basics II

1.

5 points

What is the difference between the AHI and RDI?

The AHI calculates respiratory events based on TST, while RDI calculates based on TRT. RDI also includes calculation or RERAs.

The AHI calculates respiratory events based on TRT, while RDI calculates based on TST. RDI also includes calculation or RERAs.

The AHI is found on a Type I test, and an RDI is found in a HST

There is no difference

2.

5 points

Medicare requires to see a sleep test for every patient, no matter what the diagnosis is.

True

False

3.

5 points

A patient with an E0471 can be diagnosed with OSA.

True

False

4.

5 points

The billing codes for Bi-Levels are what, and what is the term used by Medicare?

E0470 & E0471, BiPAP and BiPAP ST

E0601 & E0471, C/BiPAP

E0470 & E0471, Respiratory Assist Device

E0470 & E0471, Respirator Acclimation Device

5.

5 points

There is a separate policy for diagnoses other than OSA.

True

False

6.

5 points

An E0470 can be issued to a patient with an OSA -OR- a Non OSA diagnosis.

True

False

7.

5 points

Which 2 organizations are recognized by Medicare for accreditation purposes?

Joint Commission & American Academy of Sleep

American Academy of Sleep & OSHA

Joint Commission & Inspector General

American Academy of Sleep & Sleep USA

8.

5 points

A treating physician can be anyone that is involved in the patient's care. A treating physician can be someone other than an MD or DO, and can evaluate the patient as well as sign orders. Who can be a treating physician?

NP, PA, CNS

NP, PA, RN

PA, NP, MA

CNS, PA, NP, MA

9.

5 points

Documentation of a phone conversation is acceptable to be used as an office exam.

True

False

10.

5 points

It is acceptable for a DME supplier to create forms and have the physician sign it in lieu of an office exam note.

True

False

11.

5 points

When a patient re-starts or requalifies, they must have both _____ and ______.

A new office evaluation and a new delivery ticket signed

A new sleep test and new Rx

A new office evaluation and new sleep test

A new office evaluation and new Rx

12.

5 points

When is an HST not acceptable?

When a patient has to get a new sleep test due to re-qualification and when the diagnosis is not OSA.

When a patient has to get a new sleep test due to re-qualification & when the diagnosis is OSA.

HSTs are always acceptable

When a patient has to get a new sleep test due to re-qualification, when the diagnosis is not OSA, and if was performed prior to 3/2008.

13.

5 points

Scenario 1:
A patient received an E0601 on 11/1/10 and the doctor is ordering for a replacement E0601 because the patient wants a newer model. This order can be processed.

True

False

14.

5 points

Scenario 2:
You received a sleep test that meets AHI requirements. The treating physician who interpreted the reports is a nurse practitioner. You can take this report.

True

False

15.

5 points

Scenario 3:
My patient wants supplies through Medicare and just enrolled 1/1/13. I have a FTF that discusses use and benefit dated 11/1/12. I can use this note.

True

False

16.

5 points

Scenario 4:
A physician's assistant signed an order for a patient. I am able to locate her NPI number on the NPPES website. I can take this order.

True

False

17.

5 points

Scenario 5:
A physician sends over a new order for supplies - he wants to use his own prescription and will not sign a detailed order. He writes "mask of patient's choice" and standard tubing. What can be issued and can this Rx be used more than 1 time?

Just like the prescription says & Yes.

The mask suggested on the sleep test along with the tubing & Yes.

1 heated tubing & Yes.

1 standard tubing & No.

18.

5 points

Scenario 6:
The patient was setup with a CPAP in 2010. The initial office visit doesn't assess the patient for OSA. I can ask the doctor for an addendum for that note.

True

False

19.

5 points

Scenario 7:
A sleep study performed in 2009 was not signed by the interpreting doctor. The doctor that sent over the referral is a new doctor for the patient. Who should I contact first for the signed report?

The current physician should have it - paperwork is always transferred to the current provider of care

The previous DME that serviced the patient

The patient - he/she should have been given a copy

The sleep center where the study was performed

20.

5 points

Scenario 8:
A patient is a first time CPAP user and has failed compliancy. What must he/she do?

Keep the PAP and re-start

Seek the guidance of a technician and continue using the device

Return the PAP and re-start

See the doctor for recommendations and continue trying to use the PAP