Medicare/Cms And Hyperbaric Oxygen Therapy Quiz

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| By Rowicker
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Rowicker
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Quizzes Created: 2 | Total Attempts: 9,077
Questions: 16 | Attempts: 986

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Medicare Quizzes & Trivia

This quiz is a familiarization quiz on Medicare and hyperbaric oxygen therapy. Good luck!


Questions and Answers
  • 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 Contractor
    Explanation
    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.

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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 facilities
    Explanation
    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 security

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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. 15
    Explanation
    There were a total of 15 MAC's awarded contracts by Medicare.

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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 Determination
    Explanation
    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.

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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/CMS
    Explanation
    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.

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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 Contractors
    Explanation
    MAC Contractors publish the LCD.

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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. False
    Explanation
    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".

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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 Policy
    Explanation
    Unlike Medicare and the MACs, private insurance companies publish a "Medical Policy" for HBOT.

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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. True
    Explanation
    Read the LCD (Page 5) http://hbotechblog.files.wordpress.com/2009/07/palmettogba_lcd.pdf

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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 above
    Explanation
    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.

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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. Yes
    Explanation
    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).

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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 necrosis
    Explanation
    http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.29&ncd_version=3&basket=ncd%3A20%2E29%3A3%3AHyperbaric+Oxygen+Therapy

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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. C1300
    Explanation
    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.

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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. 99183
    Explanation
    The correct code that the Physician bills Medicare for each session of HBO therapy is 99183.

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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. False
    Explanation
    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 INFORMATION

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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

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 24, 2009
    Quiz Created by
    Rowicker
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