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 under- standing of billing
procedures and reimbursement strategies.
Q: I am an O&P provider located in the Region A area
of Medicare. I recently heard about a change that will take effect
on April 1 that Medicare will no longer allow submission of claims
with the doctor's UPIN number being OTH000. This is a generic UPIN
number that we have used when we are unable to obtain the correct
doctor's UPIN number. Is this information true or just a
rumor?
A: Yes, the information is correct. As of April
1, 2006, the DMERCs will be returning claims as unprocessable if
the doctor's UPIN number is defaulted as the generic OTH000. Claims
with dates of service of April 1, 2006, and forward must contain
the correct doctor's UPIN number in order for the claim to be
processed and paid.
Q: I am a provider located in South Carolina and have a
patient who requires prefabricated thermoformable liners. Can you
let me know what codes I would use to bill these
items?
A: The correct coding for prefabricated
thermoformable liners is L-5673 (addition to lower extremity,
bk/ak, custom fabricated from existing mold or prefabricated,
socket insert, silicone gel, elastomeric or equal, for use with
locking mechanism); or L-5679 (addition to lower extremity, bk/ak,
custom fabricated from existing mold or prefabricated, socket
insert, silicone gel, elastomeric or equal, not for use with
locking mechanism).
Q: I have billed Medicare in the past and have been paid
for K-0670, and now have recently received a denial (CO-16) for the
same code.
A: Effective January 1, 2006, K-0670 is no
longer a valid code. If your date of service is after January 1,
2006, then you should bill with code L-5858 instead.
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 - February 2006
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