Podcast
Questions and Answers
Which type of equipment is NOT included in the scope of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)?
Which type of equipment is NOT included in the scope of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)?
- Bathroom Equipment
- Traction and trapeze Equipment
- Surgical Equipment (correct)
- Hospital beds and accessories
What is the purpose of the claims adjudication process mentioned in the text?
What is the purpose of the claims adjudication process mentioned in the text?
- To apply the correct pricing to medical claims (correct)
- To determine eligibility for insurance coverage
- To ensure proper documentation of medical procedures
- To authorize medical facilities and physicians
Which healthcare professional typically prescribes Durable Medical Equipment (DME)?
Which healthcare professional typically prescribes Durable Medical Equipment (DME)?
- Chiropractor
- Medical Doctor (MD) (correct)
- Registered Nurse (RN)
- Physical Therapist
Which of the following is NOT considered a DMEPOS supply based on the provided overview?
Which of the following is NOT considered a DMEPOS supply based on the provided overview?
What is the purpose of Sub-section #1 - DME, Prosthetics and Orthotics Supplies Scope?
What is the purpose of Sub-section #1 - DME, Prosthetics and Orthotics Supplies Scope?
According to CMS, health plans must base reimbursement on a patient’s final diagnosis rather than the presenting symptoms.
According to CMS, health plans must base reimbursement on a patient’s final diagnosis rather than the presenting symptoms.
Urgent and Emergent claims are considered at the Out of Network (OON) benefit level.
Urgent and Emergent claims are considered at the Out of Network (OON) benefit level.
Severe and/or persistent vomiting is not considered an urgent or emergent condition.
Severe and/or persistent vomiting is not considered an urgent or emergent condition.
Claims with potential Urgent/Emergent status must be appropriately coded and identified regardless of the participation status of the Facility/Provider.
Claims with potential Urgent/Emergent status must be appropriately coded and identified regardless of the participation status of the Facility/Provider.
If a provider is in-network and a claim is denied, it is the provider's responsibility.
If a provider is in-network and a claim is denied, it is the provider's responsibility.
