Running an O&P shop gets more complicated each year. Whether you have Medicare billing or reimbursement questions, a Medicare policy question, or you just need help finding a resource, count on Got FAQs? to help you get the answers you need.
Q: I have looked everywhere and I am unable to locate a website or list that I can use to verify my referring physician's NPI number. Are you aware of any such site that may be available to providers?
A: There are a few resources that I know of that are available to providers. Try visiting www.hmedata.com/npi.asp, or ppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. A downloadable file is also available at nppesdata.cms.hhs.gov/cms_NPI_files.html
Q: I recently moved to another location and was told by Medicare that I need to fill out another provider enrollment form. Could this be possible? I am only changing my address. Is there a simple form or letter I can send to them to do this?
A: According to the Medicare Supplier Standard No. 2, suppliers are required to inform the National Supplier Clearinghouse (NSC) of any location change within 30 days. You will need to fill out certain sections of a CMS-855S application. To change an address, you only need to fill out sections 1C, 3, and 4 (only complete the sections that pertain to the data you are changing), section 13, and section 15 if you are the authorized official for you practice. If you have any questions completing this form, you may contact me directly.
Q: Can a brace (L-2036 in our case) be billed to Medicare while the patient is still in the hospital, with no talk of discharge planning since the patient has been in the hospital for more than 100 days? We understand Medicare Part A expires and Part B becomes eligible for our billing purposes. If so, how do we bill, for example, place of service code and any special modifiers?
A: When billing your claim to DMERC, you will use the RT or LT modifier, and your place of service will be 21 (inpatient hospital). For a complete list of place of service (POS) codes, visit www.cms.hhs.gov/placeofservicecodes/downloads/posdatabase.pdf
Q: I have a patient who requires some repairs to his orthosis, and since the patient is unable to come into my office, I need to travel roughly 55 miles to the patient's home. Does Medicare reimburse for a practitioner's travel time and or expenses?
A: In a perfect world Medicare would recognize the growing expenses of an O&P provider. Unfortunately in this world, travel time is included in the reimbursement of parts (L-4210) and labor (L-4205) and may not be paid separately.
Lisa Lake-Salmon is the executive vice president of ACC-Q-Data, which provides billing, collections, and practice management software and has been serving the O&P industry for more than a decade. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, contact lisa@opedge.com
