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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 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 from Medicare for K-0670
and do not understand why. I used this code in December and was
paid for it.
A: Effective January 1, 2006, procedure code
K-0670 (addition to lower extremity prosthesis, endoskeletal knee
shin system, microprocessor control, stance phase only) is no
longer valid. For dates of service after January 1, 2006, L-5858
should be used.
Q: Some of my patients cannot afford the 20-percent
Medicare co-pay. Is it okay for me just to write these charges
off?
A: The law requires the provider to make an
effort to collect the 20-percent co-insurance payment. The supplier
must keep evidence on file of the attempt to collect this from
either the patient or the secondary insurance. The supplier has an
option of waiving the co-insurance in case of hardship; however, a
supplier cannot routinely waive the 20-percent co-insurance payment
for every patient.
Q: We fit a HKAFO for a Medicare patient, and now, due
to weight loss, he needs the thigh cuff replaced. How do we bill
that? L-2999? Do we need a new script or do we add language in the
narrative?
A: Did you simply replace the cuff or were
there repairs, labor, or other materials involved? If the cuff was
replaced and there were no other repairs, you would bill with
L-2999 along with the script and LMN stating the patient had volume
changes and what caused these changes in the limb. If there were
repairs, you would use the L-4205 RP RT/LT (repair of orthotic
device, labor component) in addition to the L-4210 RP RT/LT (repair
or replace minor parts, orthotic device)
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 serving the O&P industry nationwide for
more than 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 - April 2006
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