Soft Landing Review

Are there are restrictions or limits related to therapy benefits?

• No restrictions for therapy benefits.

• 4 modalities per calendar year.

• Based only on medical necessity.

• 4 modalities per dos.

________is a small out-of-pocket dollar amount that’s paid at the time of service

• Coinsurance

• OOP Max

• Copayment

• Deductible

Medicare Advantage Plans have no lifetime maximum limits.

• True

• False

TIN 201020255  NPI 1932985314   Provider Name Emily Hays 

 Address 8241 Rochester Avenue, Rancho Cucamonga, CA, 91730 PIN 8140616

 

Member ID: 101825920400 Member Name Marshall McNott DOB 09/11/1935 

Provider is calling to quote the benefit code E0641, what would you quote for member cost share?

• 20% copayment

• 50% coinsurance

• Not a valid code.

• 20% coinsurance

Is code 75716  an automatic study for the specialty of Dermatology as of 07/01/2025?

• Yes

• No

Provider: Einstein Medical Center Montgomery TIN: 204193243 NPI: 1104192590 Address: 559 West Germantown Pike, East Norriton, PA, 19403

Member is Karen Pendleton Member ID: 101505859100 DOB: 01/30/1963

The provider is calling to obtain details regarding a precertification. Is there a precert on file for an inpatient hospital stay sent 5/14/25?

• No. There is no precert on file for an inpatient stay.

• Yes, and the auth was approved and number is #250514347492.

• Yes, however the auth was not approved and number is #250514347492.

The standard is that all hospice claims should be sent to and managed by ____________?

If a nonparticipating provider is requesting payment information and they accept assignment...
Then the payment is....

• ​Up to the Medicare Limiting Charge

• 100% of the applicable Medicare Allowable rate

• The contracted rate

• 115% x (95% x MCARE rate)

What system would you use to view correspondence mailed or faxed to us by the provider?

• MHK

• ECHS

• MedCompass

• McKesson Total Payment System -TPS

Is the procedure code 90746 covered under part b or part d?

• Part B

• No covered by medicare.

• Part D