BOC-CDME flashcards
BOC-CDME · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- DME definition
- Equipment that can withstand repeated use, is primarily used for a medical purpose, is not useful in the absence of illness, and is not worn on the body.
- Capped rental
- A Medicare payment method for certain DME items where the supplier is paid monthly for up to 13 months, after which the patient may own the equipment.
- Detailed written order
- A physician's order for DME that includes the patient's name, item, date, physician signature, and NPI; it must be received before billing.
- Proof of delivery
- Documentation showing the patient received the equipment, including the patient's name, item, delivery date, and recipient's signature.
- Certificate of Medical Necessity
- A form required for certain DME items, such as oxygen and CPAP, signed by the physician to attest to the medical need.
- Advance Beneficiary Notice
- A notice given to a patient when the supplier expects Medicare to deny payment, allowing the patient to choose whether to receive the item.
- Competitive bidding
- A Medicare program in which suppliers compete for contracts to furnish certain DME items in specific areas at set payment rates.
- Oxygen qualification
- Medicare requires a blood gas test showing PaO2 ≤ 55 mmHg or oxygen saturation ≤ 88% to qualify for home oxygen therapy.
- CPAP requirements
- A CPAP device requires a diagnosis of obstructive sleep apnea confirmed by a sleep test and a physician's order.
- Negative pressure wound therapy
- A modality using a vacuum pump and dressing to promote wound healing; it is billed as a capped rental item.
- Enteral nutrition classification
- Enteral nutrition is classified as a prosthetic device, not DME, and is billed under parenteral/enteral nutrition codes.
- Complex rehabilitation technology
- Specialized wheelchair seating and positioning items that require evaluations and documentation beyond standard DME.
- Supplier accreditation
- DME suppliers must be accredited by a CMS-approved organization within 18 months of enrollment to bill Medicare.
- Surety bond requirement
- Medicare suppliers must post a $50,000 surety bond per location, or $100,000 for multiple locations, to protect against fraud.
- Perpetual inventory system
- A method that continuously tracks inventory levels and serialized equipment to ensure accurate billing and asset control.
- Timely filing limit
- The deadline for submitting claims, such as 12 months from the date of service for Medicare, after which claims are denied.
- Days in accounts receivable
- A key performance indicator measuring the average number of days it takes to collect payment after billing.
- Compliance program
- A set of written policies, a compliance officer, training, and reporting mechanisms to prevent and detect violations of law.
- Anti-Kickback Statute
- A law prohibiting offering or receiving anything of value to induce referrals for items covered by federal healthcare programs.
- Stark Law
- A strict liability statute prohibiting physician self-referral for designated health services, including DME, unless an exception applies.
- HIPAA Privacy Rule
- A regulation requiring safeguards for protected health information and giving patients rights over their health information.
- False Claims Act
- A law imposing liability for knowingly submitting false claims to the government, with whistleblower provisions for recoveries.
- Medicare revalidation
- The process by which suppliers must periodically re-enroll in Medicare, typically every five years, to maintain billing privileges.
- Record retention
- Suppliers must keep records for at least seven years, or longer if state law requires, and make them available to Medicare.
- OIG work plan
- An annual publication by the Office of Inspector General outlining areas of focus for audits and investigations.
- Patient education
- Training provided to patients on proper use, maintenance, and safety of equipment, which must be documented.
- Patient intake process
- Steps to verify insurance eligibility, obtain prior authorization if needed, and schedule delivery of equipment.
- Customer service standards
- Guidelines such as responding to inquiries within 24 hours and resolving complaints promptly to ensure satisfaction.
- Delivery and setup
- The process of delivering equipment, demonstrating its use, and checking patient comfort and understanding.
- Follow-up call
- A call after delivery to identify issues and improve satisfaction, which should be documented in the patient record.
- Cultural competence
- The ability to provide care that respects patients' cultural backgrounds, including language access and appropriate materials.
- Patient rights
- The right to be informed of costs, refuse treatment, and privacy, which should be explained during the intake process.