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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: A patient came into my office with a
prescription for a Cam Walker. The patient had already received an
AFO brace in the beginning of the year. Will Medicare now pay for
the Cam Walker, and if so, how should I bill? Please help, as I can
not afford to keep giving products away for free.
A:Medicare will not cover a Cam Walker, since
the patient already received an AFO brace in the same calendar
year. If you give the patient a Cam Walker, you must have the
patient sign an ABN (Advance Beneficiary Notice) form, informing
the patient that Medicare will not cover this item and the cost
would be his or her responsibility. You need to bill using the GA
modifier, letting Medicare know that you have a signed ABN on file.
This will then allow you to bill the patient once Medicare
denies.
Q: I have recently received a denial using a
procedure code of L-5621. I have been using this code for the last
few years and have always been paid. Please help; I am very
confused.
A: More than likely, the reason you have
received this denial is that L-5621 is no longer a valid code. It
was replaced with L-5620 (addition to lower extremity, test socket
below knee). There are numerous ways to verify if a code is valid.
One of them would be to contact SADMERC at 877.735.1326; SADMERC is
a division of Medicare. We invite readers to ask any questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact: lisa@westernmediallc.com. 
Table Of Contents - December 2003
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