WorksheetsDSL Session 10 HOSPICE before & after lecture Quiz
Total questions: 11
Worksheet time: 4mins
To be eligible to elect hospice using the Medicare benefit an individual must
Be entitled to Part D Medicare
Be certified as terminally ill with a medical prognosis of a life expectancy of 6 months or less if the illness runs its normal course
Obtain services from a Medicare Certified Hospice Agency
Two and Three are Correct
The hospice benefit is divided into
Three 90 day periods with an unlimited number of 30 day periods
Two 90 day periods with an unlimited number of 60 day periods
Three 90 day periods and a limited number of 30 day periods
Two 90 day periods with an limited number of of 60 day periods
Which of the following prompts the Common Working File (CWF) to process the initial election?
MAC electronically transmits the NOE to CWF
MAC transmits the beneficiary election statement to FISS
MAC transmits the Face-to-Face encounter to CWF
FISS transmits the beneficiary election statement and the NOE to FISS
When an ADR is sent to the provider
The claim suspends to status location SB 6001
The claim suspends to status location DB 9997
The claim suspends to status location SM 5REC
The claim is assigned a reason code of 56900
An ADR notification letter and an ADR results letter will be sent and transmitted to
Only to the FISS system
To the address the agency has on file with Medicare
Only to the CWF
None of these answers are correct
When collecting documentation for submission to Medicare upon receipt of an ADR it is important to:
Use NGSConnex or esMD for faster & more cost effective, electronic submission
Return documents to CMS by day 60 from the date listed on the notification letter
A, B & D are correct
Perform a quality review of ADR prior to submission
Upon submission of paper medical records to NGS, do not:
copy records as PDF
bind records together with staples, clips or rubberbands
highlight, alter or attach sticky notes to pages
All of the above
Records not received in a timely manner are
Automatically appealed by the MAC for payment
Given a telephone call as a reminder for submission
Denied in full with a 56900 denial code
Added to the list of providers referred to the UPIC for fraud
Current hospice edits include:
Pre & Post Pay Place of Stay
Length of Stay
Post Pay Place of Stay
Place of Service
The most current hospice denials do not include
55H1L: Information does not support terminal prognosis of six months or less
55H2B: The patient is not homebound
55H1Y: Physician narrative statement not present or not valid
55H1R: The notice of election is invalid because it does not meet statutory regulatory requirements
Which of the following is not a way to avoid top hospice claim denials:
Quality review of records following submission to the MAC
Ensuring documentation supports terminality
Ensuring dates and signatures are appropriate
Timely submission of medical records upon receipt of the ADR
