Denials are difficult to identify and time-consuming to appeal. If you have a billing question or a question about a denial, "Got FAQs?" can help you sift through the confusion and get you the answers you need. This month's column addresses your questions about definitions of acceptable prescriptions, workers' compensation claims, and CMS rules on chiropractic services.
Q: I have worked as a billing manager in several medical offices, and I am sure I am clear on the definition of an "acceptable prescription." However, the new practitioner I am working for does not believe what I am telling him about the information that needs to be included on a prescription. Can you please confirm what information must be included?
A: According to the Centers for Medicare & Medicaid Services (CMS) guidelines, "Written orders may take the form of a photocopy, facsimile image, electronically maintained, or original 'pen-and-ink' document." (CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.3.) The elements required on all written orders include the following:
- Beneficiary name.
- Detailed description of the item (either a narrative description or a brand name/model).
- All options and accessories that will be billed separately or that require an upgraded code.
- Signature of the treating physician, and the date the order is signed; an initial date of need or start date.
- If the written order is for a rental item, the length of need is also required.
- Someone other than the treating physician may complete the detailed description of the item. However, the treating physician must review the detailed description and personally sign and date the order to indicate agreement.
Q: We recently started doing work for a group of physicians who address numerous workers' compensation claims. I'm having a difficult time getting anywhere with some of these insurance companies. Are there any Florida companies that can assist in billing these claims? Where can I find information on billing guidelines for these claims?
A: There are numerous networks that will assist you in providing services for injured workers and getting reimbursed for the services provided by the physicians for whom you work. Since you requested a company in Florida, I recommend contacting PMSI, Tampa. They also have an informative website that provides every state's workers' compensation laws and regulations. You may view this information at www.pmsionline.com/laws-regulations-and-forms
Q: A physician group that includes chiropractors has recently approached us to provide services. My partner says he recently read that we could accept prescriptions from chiropractors as well as the other physicians. I thought I had read somewhere that a prescription from a chiropractor is not valid or acceptable. Can you please settle this for us?
A: On August 22, 2011, CMS issued the following statement: "In recent announcements and materials, CMS incorrectly included chiropractors in the list of physician and practitioner types that may order and refer items or services to Medicare beneficiaries. In accordance with section 1877(a)(1) and (5)(A), and section 1861(r)(5) of the Social Security Act, and 42 CFR 410.21(b)(1) and (2), doctors of chiropractic medicine are not eligible to order and refer. Medicare coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation; all other services furnished or ordered by chiropractors are not covered. CMS is in the process of revising documents (including change requests) to reflect this correction." This information can be viewed at www.oandp.com/link/124
Lisa Lake-Salmon is the president of Acc-Q-Data, which provides billing, collections, and practice management software. She has been serving the O&P profession for more than a decade. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact or visit www.acc-q-data.com