Funding & Insurance for Mobility Equipment Flashcards
7 cards from real CMC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Funding & Insurance for Mobility Equipment flashcards as text
Which HCPCS code grouping is used specifically for Complex Rehab Technology (CRT) power wheelchairs to distinguish them from standard power chairs?
Answer: K0835–K0864 (Group 3 and Group 4 power wheelchairs)
HCPCS K0835–K0864 cover Group 3 and Group 4 power wheelchairs that qualify as CRT, distinguishing them from Group 1 and 2 standard chairs.
A client is denied Medicare coverage for a power wheelchair because the clinical documentation does not demonstrate the inability to self-propel a manual chair. This reflects which Medicare coverage criterion?
Answer: The patient must be unable to use a less costly alternative device
Medicare applies a least-costly alternative principle, requiring documentation that less complex equipment cannot meet the patient's mobility needs before approving a power chair.
What is 'assignment' in Medicare DME billing, and why does it matter for patients?
Answer: The supplier agrees to accept Medicare's approved amount as full payment, limiting patient out-of-pocket costs
When a supplier accepts assignment, they cannot bill the patient more than the Medicare copay (20%) and deductible, protecting patients from balance billing.
A Medicaid waiver program such as HCBS (Home and Community-Based Services) is used primarily to fund which type of mobility equipment scenario?
Answer: Equipment that enables individuals to remain in the community rather than institutional settings
HCBS waivers allow states to fund services and equipment that help individuals with disabilities live in community rather than nursing facility settings.
Which federal act prohibits insurers from imposing lifetime or annual dollar limits on essential health benefits, directly impacting funding for mobility equipment?
Answer: Affordable Care Act (ACA)
The ACA prohibits lifetime and annual dollar limits on essential health benefits, ensuring ongoing coverage for medically necessary mobility equipment is not capped.
A supplier provides a loaner manual wheelchair while a client's power chair insurance claim is pending. Which concept describes this practice?
Answer: Temporary/loaner equipment provision during claim adjudication
Providing a loaner ensures continued mobility access during the claim review period without committing to the final dispensing arrangement.
Under Medicare's Competitive Bidding Program for DME, which geographic area determines the reimbursement rate a supplier receives for a standard manual wheelchair?
Answer: The Competitive Bidding Area (CBA) where the item is delivered to the beneficiary
Medicare's competitive bidding rates are set by the CBA (metropolitan statistical area) where the equipment is actually delivered to the beneficiary.