Medicare/Cms And Hyperbaric Oxygen Therapy Quiz
This quiz is a familiarization quiz on Medicare and hyperbaric oxygen therapy. Good luck!
- 1.
What is a Medicare MAC?
- A.
Medicare Accounting Company
- B.
Mickey Mouse acting Cool
- C.
Media Assessment Corporation
- D.
Medicare Administrative Contractor
- E.
Medicare Accreditation Cooperation
Correct Answer
D. Medicare Administrative ContractorExplanation
A Medicare Administrative Contractor (MAC) is the new contracting entity that is responsible for the receipt, processing and payment of Medicare fee-for-service claims.Rate this question:
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- 2.
Which is not a Medicare MAC's responsibility?
- A.
Claims processing
- B.
Beneficiary and provider customer service
- C.
Appeals (in-case of denials)
- D.
Provider education
- E.
Qualifying Hyperbaric patients for facilities
Correct Answer
E. Qualifying Hyperbaric patients for facilitiesExplanation
The primary responsibilities of each MAC (Medicare Administrative Contractor) are the following:
• Claims processing
• Beneficiary and provider customer service
• Appeals (in-case of denials)
• Provider education
• Financial management
• Provider enrollment
• Reimbursement
• Payment safeguards
• Information systems securityRate this question:
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- 3.
How many MAC's in total were awarded contracts by Medicare?
- A.
15.5
- B.
12
- C.
18
- D.
15
- E.
20
Correct Answer
D. 15Explanation
There were a total of 15 MAC's awarded contracts by Medicare.Rate this question:
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- 4.
What is an NCD?
- A.
Narcotics Crime Division
- B.
National Coverage Determination
- C.
Network Coverage Diary
- D.
National Covert Department
- E.
National Couter-terror Desk
Correct Answer
B. National Coverage DeterminationExplanation
An NCD stands for National Coverage Determination, which refers to a decision made by the Centers for Medicare and Medicaid Services (CMS) regarding whether a specific medical service or item is covered by Medicare. This determination is based on evidence-based research and clinical guidelines to ensure appropriate and consistent coverage for beneficiaries.Rate this question:
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- 5.
Who publishes the NCD?
- A.
Medicare/CMS
- B.
MAC contractors
- C.
Physicians
- D.
HBO techs
- E.
Physicians and HBO techs
Correct Answer
A. Medicare/CMSExplanation
Medicare/CMS publishes the NCD (National Coverage Determinations). NCDs are policies that determine whether a particular item or service is covered by Medicare. Medicare/CMS is responsible for setting the guidelines and regulations for coverage and reimbursement under the Medicare program. They provide the necessary information and updates regarding coverage decisions to ensure that healthcare providers, beneficiaries, and other stakeholders are aware of the approved services and treatments.Rate this question:
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- 6.
Who publishes the LCD?
- A.
Medicare/CMS
- B.
MAC Contractors
- C.
Physicians
- D.
HBO techs
- E.
Physicians and HBO techs
Correct Answer
B. MAC ContractorsExplanation
MAC Contractors publish the LCD.Rate this question:
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- 7.
True or False. If Medicare pays for Chronic Refractory Osteomyelitis this means that all insurance companies pay for it as well.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Just because Medicare pays for it does not mean that all private insurances will. Some only pay for acute osteomyelitis. Check the insurance company's "HBO Medical Policy".Rate this question:
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- 8.
Private Insurance companies publish their own guide for HBO therapy. This guide is called a ______________ _______________.
- A.
Medicinal Procedure
- B.
Medical Policy
- C.
Medical Promoter
- D.
Medical Paper
- E.
Medical Determination
Correct Answer
B. Medical PolicyExplanation
Unlike Medicare and the MACs, private insurance companies publish a "Medical Policy" for HBOT.Rate this question:
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- 9.
In the Region 1 MAC LCD (Palmetto GBA) it states that; Claims for HBO submitted with ICD-9-CM codes 040.0, 444.21, 444.22, 444.81, 728.86, or 999.1 are presumed to be HBO therapy provided to inpatients requiring acute/emergent treatment. Services rendered on an outpatient basis (using outpatient bill types) will be considered medically unnecessary and will be denied. TRUE or FALSE?
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Read the LCD (Page 5) http://hbotechblog.files.wordpress.com/2009/07/palmettogba_lcd.pdfRate this question:
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- 10.
How can you ensure that you have the correct up-to-date Medical Policy for HBOT from private insurance companies?
- A.
Call the insurance Company and request the Medical Policy for HBOT
- B.
Be persistent and make it sound urgent
- C.
Check online to see if it is posted on the company's website
- D.
Look at the date on the first page of the Medical Policy
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
To ensure that you have the correct up-to-date Medical Policy for HBOT from private insurance companies, you can follow multiple steps. Firstly, you can call the insurance company and request the Medical Policy for HBOT. Secondly, being persistent and making it sound urgent can help in obtaining the policy. Additionally, checking online to see if the policy is posted on the company's website can provide the necessary information. Lastly, looking at the date on the first page of the Medical Policy can confirm if it is up-to-date. Therefore, all of the above steps should be taken to ensure the correctness and up-to-dateness of the Medical Policy.Rate this question:
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- 11.
Are LCD's losely based on NCD's or is it the other way around?
- A.
Yes
- B.
No
- C.
Depends on who you ask
- D.
Maybe
- E.
It's the other way around
Correct Answer
A. YesExplanation
LCD's are losely based on the NCD's published by Medicare. NCD's always supercede LCD's (although LCD's contain a lot more detailed information).Rate this question:
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- 12.
Which indication is not a covered indication by Medicare?
- A.
Chronic Refreactory Osteomyelitis
- B.
Wagner Grade 3 Diabetic wounds that have not significantly improved in 30 days
- C.
Osteoradionecrosis
- D.
Hepatic necrosis
- E.
Preparation and preservation of compromised skin grafts
Correct Answer
D. Hepatic necrosisExplanation
http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.29&ncd_version=3&basket=ncd%3A20%2E29%3A3%3AHyperbaric+Oxygen+TherapyRate this question:
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- 13.
What code does the facility/Hospital bill Medicare for every 30 minutes of HBO therapy?
- A.
ICD-9000
- B.
C1300
- C.
99183
- D.
C99183
- E.
86-75-309
Correct Answer
B. C1300Explanation
86-75-309 definitely is not correct (although it's a great song). C1300 is the facility billing code for each 30 minutes of HBOT.Rate this question:
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- 14.
What code does the Physician bill Medicare for each session of HBO therapy?
- A.
ICD-9000
- B.
C1300
- C.
99183
- D.
C99183
- E.
86-75-309
Correct Answer
C. 99183Explanation
The correct code that the Physician bills Medicare for each session of HBO therapy is 99183.Rate this question:
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- 15.
Is this statement TRUE or FALSE? Only Wagner Grade 3 wounds from the ankle and below qualify for HBOT.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Claims for HBO for the treatment of diabetic wounds of the lower extremities require documentation of dual
diagnoses. An ICD-9-CM code from either the 249.70-279.71, 249.80-249.81, 250.70–250.73 or
250.80–250.83 range (representing a diabetes-related problem) and one of the following ICD-9-CM codes:
707.10 - Unspecified
707.12 - Ulcer of Calf
707.13 - Ulcer of Ankle
707.14 - Ulcer iof Heel and Midfoot
707.15 - Ulcer of other part of foot/toes
707.19 - Ulcer of other part of lower limb
CHECK YOUR LCD FOR FURTHER INFORMATIONRate this question:
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- 16.
If you live in California which MAC's LCD should you have?
- A.
National Government Services
- B.
First Coast
- C.
Trailblazer
- D.
Noridian
- E.
Palmetto GBA
Correct Answer
E. Palmetto GBA -
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
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Mar 21, 2023Quiz Edited by
ProProfs Editorial Team -
Aug 24, 2009Quiz Created by
Rowicker
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