Got FAQs?
By Lisa Lake-Salmon Executive Vice President, Acc-Q-Data Inc.  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 saw your article in The O&P EDGE. I have
been getting denied by Medicare left and rightand not only for
diabetic shoes. Knee braces are also a big denial item. I am using
diagnosis 715.9 for osteoarthritis&they will deny as the day is
long. Should I use DJD? I am desperate and frustrated. It isnt
funny&HELP!
A:The reason you are receiving these
denials is due to your diagnosis not going to the fifth digit. It
is safe to presume that the patient has osteoarthritis of the knee
or lower limb. Therefore, in this case the proper diagnosis would
be 715.96: osteoarthritis of the lower leg.
Q: I have previously experienced a few patients that
came to us wanting a new prosthesis because the one they received
from their previous provider was ill-fitting or not working for
them. What guidelines or protocol should we follow when consulting
the patient on manufacturing a new leg for them?
A: Medicare has a certain time limit
on how often a patient can receive a new leg. You would first need
to obtain records from the previous provider showing that either
the patient and/or provider made several attempts to rectify the
problems with the prosthesis. These records could include, for
example, progress notes showing adjustments and corrections that
were made, any replacements of components, and medical records
relating to the patients problem area.
Then, you will need to have the patient sign an Assignment of
Benefits (AOB), which advises him/her that if for any reason
Medicare should deny the claim, he/she might be responsible. I
would advise that you send this claim hardcopy with all additional
documentation and medical notes.
We invite readers to ask any questions you have regarding
billing, collections, or any other related information. To send
your 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. 
Table Of Contents - November 2003
|
