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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 eff ectively
increase your reimbursement. This informative column will help
providers and their staff with a better understanding of billing
procedures and reimbursement strategies.
Q: I recently received a denial for a tibial length
sock, yet I was paid for the AFO. Why would Medicare not pay for
the sock?
A: L-2840 (addition to lower extremity
orthosis, tibial length sock, fracture or equal), and L-2850
(addition to lower extremity orthosis, femoral length sock,
fracture or equal) used in conjunction with orthoses are
noncovered. Therefore, there would be no reimbursement for these
codes.
Q: I billed Medicare for an L-8035 and received
payment for an L-8030. Why would Medicare downcode this to a less
expensive prosthesis?
A: According to Region C, the additional
features of a custom-fabricated prosthesis (L-8035), compared to a
prefabricated silicone breast prosthesis, are not medically
necessary. Therefore, if an L-8035 is provided to a patient who has
had a mastectomy, payment will be based on the allowance for the
least costly appropriate alternative, L-8030.
Q: Is it true that a provider will need to have a
specialty code in the future in order to bill Medicare? How do I
know what my code is and if I have one?
A: Effective July 1, 2005, Medicare will only
reimburse for prosthetics and certain custom-fabricated orthotics
when furnished by a qualified practitioner or a qualified supplier.
If you want to bill Medicare for P&O, you should contact the
National Suppliers Clearinghouse (NSC) at 866.238.9652 to verify
that it has your correct specialty code on file. If you need to
update your file with the correct specialty code, you must submit a
change of information to the NSC on a CMS 855S form.
We invite readers to ask any questions you may 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. For more information contact lsalmon@acc-q-data.com
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc. 
Table Of Contents - May 2005
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