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Got FAQs?
By Lisa Lake-Salmon  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: I am an O&P provider who has been billing claims
to Medicare for AFO braces and Velcro® closures. I used the
L-2999 for the Velcro closures, and it was denied as not
covered.
I have accepted this denial for some time now, but recently found
out from another provider that they have been billing the same
codes/items and received payment. What am I doing
wrong?
A: When billing miscellaneous codes
such as L-2999, L-3999, etc. to Medicare, you need to submit the
claim with the pertinent information in the additional
documentation field (HAO field). The claim for code L-2999 must
include a narrative description of the item, the brand name and
model name/number of the item, and a statement defining the medical
necessity of the item for the particular patient. For example, a
complete description would be heel puller straps attached to AFO or
1/4 inch of Dacron-backed Velcro for patients AFO. By doing this,
you are giving Medicare the necessary documentation required to
review and process the claim accordingly.
Q: I am a provider located in Region C, and recently
I have been receiving numerous denials on osteoarthritis unloader
braces and knee braces L-1844, L-1858, etc. Also, I have noticed a
major delay in payment, if any is made. Is there something I can do
to prevent the delay or avoid receiving denials on these
claims?
A: According to Region C, they
recently have been experiencing an abundance of claims being billed
for knee braces. They have been denying these claims for C0-16
(lacking information needed to process claim) or CO-50 (not
medically necessary). Sometimes a standard audit letter is issued
to the provider requesting a delivery ticket, referring physicians
notes, and an AOB signed by the patient. If you have all of the
above-requested information on file, you should send it hardcopy
with the initial submission of the claim. This will help avoid the
standard audit letter being sent out, which creates the delay in
reimbursement of your claim. Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc. 
Table Of Contents - October 2003
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