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Quiz yourself on medical necessity

HIM Connection, November 9, 2004

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1. True or false: Medicare considers medical necessity to be a determination of whether a service is reasonable and necessary to diagnose or treat an illness or injury or to improve the functioning of a malformed body member.

2. Which of the following is a financial-liability provision that does not require a beneficiary signature on the ABN?
   a. NCD
   b. RR
   c. LMRP
   d. LOL

3. True or false: Third parties may reimburse a service designated as a noncovered under certain circumstances.

4. Which of the following are referring physicians required to do?
   a. Include actual ICD-9-CM codes on a test order
   b. List actual CPT codes on a test order
   c. Provide a narrative description of signs/symptoms or diagnosis
   d. Both a and c

5. Which of the following does CMS consider to be a test order?
   a. A written document signed by the treating physician that may be hand-delivered, mailed, or faxed to the testing facility
   b. A telephone call by the treating physician or his or her office to the testing facility
   c. Electronic mail by the treating physician or his or her office to the testing facility
   d. All of the above

6. What is an LMRP?
   a. Low medical reimbursement payment
   b. Local medical review policy
   c. Last minute refusal to pay
   d. Local medical reimbursement policy

7. Which of the following will Medicare contractors begin issuing by October 2005?
   a. NCDs
   b. ABNs
   c. LCDs
   d. LMRPs

8. True or false: Providers can submit requests for reconsideration to have LMRP content modified.

9. True or false: Facilities can obtain ABNs after a patient has received a diagnostic test.

10. In the absence of signs or symptoms, how does Medicare describe a diagnostic exam?
    a. Preventative
    b. Screening
    c. Diagnostic
    d. None of the above

Answer Key:

1. True; 2. d; 3. False; 4. c; 5. d; 6. b; 7. c; 8. True; 9. False; 10. b

This excerpt is adapted from the Medical Necessity Training Handbook for Nurses and Hospital Staff.

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