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 recently received a denial
for Code L-1885, stating "invalid procedure code." I was informed
the replacement code was E-1810, so I billed it to Medicare with a
LT modifier and received a denial as CO-16. I was informed that the
modifier I used was incorrect. Please help, as I am very confused
on what I need to do to get this paid?
A: Code E-1810 (dynamic adjustable knee
extension /flexion device) needs to be billed as a capped rental on
a monthly basis. Your modifiers would be RR KH LT. Each month the K
modifier will be different, according to what month the rental is
in. For example RR KH LT (first month), RR KI LT (second month),
and so on. The allowable for the state of New York is $116.14 per
month.
Q: I am located in the Region C area and
received payment for a claim I billed. I noticed that when the
payment came in, I had billed one of the codes at the wrong price.
Is there a faster way to get Medicare to correct my claim, with the
corrected price, without having to send the claim into review?
A: Yes. You can contact Medicare Region C phone
review unit. Explain that there was a billing error and give the
corrected price over the phone, and your claim will enter the
review unit much quicker than sending it in hard copy. There are
many different types of denials for which Medicare permits phone
reviews. For example: If you billed with the wrong procedure code
or billed with an incorrect price, you can contact Medicare phone
review for correcting the claim.
We invite readers to ask 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.
Lisa Lake-Salmon Executive Vice President Acc-Q-Data Inc. 
Table Of Contents - August 2005
|
