 |
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 billed a breast prosthesis L-8030 to Medicare
and received a denial for CO-57 (same or similar). How often is a
patient allowed to receive a breast prosthesis from
Medicare?
A: According to Medicare guidelines, a patient
is allowed one breast prosthesis every two years. I suggest when
documenting the patient's history, you should specify when the
patient received her last breast prosthesis. According to a Region
C Medicare representative, if this is documented properly, you can
then send the claim to review and they would consider payment if
you have documentation of the patient's history, showing that
inappropriate information was given by the patient. If Medicare
still denies your claim, you may request a telephone hearing.
Q: I am a Region D provider and received payment
from Medicare for a patient who, we have since learned, has other
insurance as primary. We would like to return the money to Medicare
even though they did not request it from us. Please let me know
what we need to do.
A: Cigna, the Medicare administrator for Region
D, has a form for voluntary overpayment refunds. This form can be
found in Chapter 12 of the supplier manual under the section titled
"Overpayments and Refunds."
Q: I recently received payment on claims that were
for DOS May and June of 2003. I noticed that we were not paid
according to the fee schedule, and we don't know
why.
A: The law requires that the claim be filed no
later than the end of the calendar year following the year in which
the service was furnished. However, if the services were in the
last three months of the year, then claims must be filed no later
than December 31 of the second year following the year in which the
services were rendered. According to the Omnibus Budget
Reconciliation Act of 1989, assigned Medicare claims must be filed
within one year from the date of service or the payment will be
reduced by 10 percent.
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
Acc-Q-Data provides billing, collections, and practice
management software serving the O&P industry nationwide for
over a decade. Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc. 
Table Of Contents - October 2004
|
|
