10 Questions
Which type of equipment is NOT included in the scope of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)?
Surgical Equipment
What is the purpose of the claims adjudication process mentioned in the text?
To apply the correct pricing to medical claims
Which healthcare professional typically prescribes Durable Medical Equipment (DME)?
Medical Doctor (MD)
Which of the following is NOT considered a DMEPOS supply based on the provided overview?
Surgical Gloves and Gowns
What is the purpose of Sub-section #1 - DME, Prosthetics and Orthotics Supplies Scope?
To provide general instructions on pricing professional claims for DMEPOS
According to CMS, health plans must base reimbursement on a patient’s final diagnosis rather than the presenting symptoms.
False
Urgent and Emergent claims are considered at the Out of Network (OON) benefit level.
False
Severe and/or persistent vomiting is not considered an urgent or emergent condition.
False
Claims with potential Urgent/Emergent status must be appropriately coded and identified regardless of the participation status of the Facility/Provider.
True
If a provider is in-network and a claim is denied, it is the provider's responsibility.
True
Learn about the scope and overview of services listed in the DLP's purpose section related to the claims adjudication process. Understand the steps taken to ensure the correct pricing of claims, including authorization, eligibility for payment, coverage, coding accuracy, and billing correctness.
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