The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.
Q: Can you please explain what the remark code is on
the Medicare remittance advice?
A: The remark code is a code on the left side of
the claim data that informs you of that particular claims
adjustment, denial, or payment reason. Do not forget to look at the
remark code (i.e., M51 = missing/incomplete/invalid procedure code)
before calling Medicare to inquire about the claim. This could save
you precious time!
Q: Are suppliers required to request an appeal for a
non-assigned claim?
A: No. Under mandatory submission of claims, a
supplier has fulfilled his/her obligation by filing a non-assigned
claim. The beneficiary or his/her authorized representative (which
may be the supplier if requested by the beneficiary) must request
the appeal on a non-assigned claim.
Q: I received a denial on a thoracic-lumbar orthosis
as not medically necessary, and I am not sure why. When does
Medicare consider this item medically
necessary?
A: According to DMERC, this type of orthosis is
covered when it is ordered to reduce pain by restricting movement
of the trunk; or to assist healing following an injury to the spine
or related soft tissue; or to support weak spinal muscles and/or a
deformed spine; or to facilitate healing following a surgical
procedure on the spine or related soft tissue.
We invite readers to ask any questions you may have regarding billing, collections, or any other information. To sendyour questions or for more information, contact:lisa@westernmediallc.com
Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for over a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc.
