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 billed Medicare for
a prosthetic leg, and all the codes were paid for with the
exception of Code L-5685. This claim is now pending as needing
additional information. I can't seem to find out what information
is needed for Medicare to pay. Please help, so I can get this code
paid!
A: When Code L-5685 is billed, the claim must
include a narrative description of the item, the manufacturer, and
the model name or number (if applicable). By supplying this
information to Medicare, your claim/code will be paid.
Q: I am located in Region C for Medicare and I
have a claim that needs to go to fair hearing. I am not sure of the
process for filing. Do you need a specific form? Is there a dollar
amount limit? Please help, as this is the first time I am
requesting a hearing.
A: The address for Region C ALJ (administrative
law judge) hearings is: Palmetto GBA, PO Box 100106, Columbia, SC
29202-3106. Please note that you must submit a hearing form along
with your information. You can obtain the hearing form (CMS-5011B)
from the Medicare Region C website (www.cms.hhs.gov/forms/
cms5011A-B.pdf).
Your claim must be a minimum of $100. If your claim is under
$100, you may combine multiple claims to meet the minimum amount in
question for an ALJ appeal request. You must include, in your
appeal request, the specific claims that are being aggregated. If
your request does not state the designated claims that are being
aggregated, each claim will be treated as a separate request and
those not meeting the $100 minimum will be dismissed.
We invite readers to ask 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 
Table Of Contents - September 2005
|
