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: Recently and in the past I have billed code K-0628
and K-0629, which are diabetic inserts. I have been informed by
Medicare to bill these codes two different ways, and at this time I
am still unsuccessful in getting them paid. Please help me get
these codes paid.
A: Codes K-0628 and K-0629 are diabetic inserts
that go along with diabetic shoes. In order for these codes to be
covered, the patient must be a diabetic, therefore using a diabetic
diagnosis code, e.g. 250.00. You also must use the modifiers LT /
RT specifying which foot, if not both, and KX modifier, which
informs Medicare that the shoes are covered due to the patient
being a diabetic.
Q: I recently have submitted claims to Medicare Region C
for patients that reside in Region B; my office is located in
Region C. We have received denials, and Medicare informed us that
we needed to submit paper claims to Region B. I was under the
notion that if we submitted the claims to Region C, they would be
forwarded to the correct Region if necessary. Please tell me what I
am doing wrong.
A: In order to submit claims to a different
Region, other than the Region your office is located in, you must
have the correct information on the claim, e.g. the patient's
address and state must fall under the Region you are billing to.
You are able to submit directly to the Region where the patient
resides electronically or via hardcopy. Medicare will not forward
claims to a different Region from the one you submitted to
originally.
Q: We currently have encountered a situation with
Medicare Region C denying some of our non-assigned claims that were
billed with a GA modifier and submitted with a signed ABN form.
Medicare stated that we had to refund the payment that the patient
paid for claims that denied with a CO denial code, even though we
had an ABN on file. Our question is: Can Medicare ask us to refund
the patient's money even though we billed with the GA modifier and
submitted an ABN?
A: Yes, Medicare can ask you to refund the
money. You cannot bill a non-assigned claim with a GA modifier,
even with an ABN (Advanced Beneficiary Notice) on file. You must
use a GY modifier when submitting a non-assigned claim with NO ABN
on file. The only way you can utilize the ABN modifier (GA) is when
billing a claim as accepting assignment.
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@opedge.com
Acc-Q-Data provides billing, collections, and practice
management software and has served the O&P industry nationwide
for more than a decade. 
Table Of Contents - January 2006
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