Got FAQs?
By Lisa Lake-Salmon .jpg) 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 have a patient who has New Jersey Medicaid as their primary insurance. We billed for diabetic shoes A-5500 KX and we received a denial for invalid procedure code. I am confused since I know this is a valid procedure code.
A:
When billing New Jersey Medicaid for diabetic shoes you must use L-3216 (ladies shoes) and L-3221 (men's shoes). For diabetic inserts use L-3030. Please note you do not use any modifiers for these procedure codes when billing New Jersey Medicaid.
Q: Yesterday we received an updated fee schedule from Region B, and K-0628 was not on the fee schedule. Have you heard anything about them changing this? Please let me know what the allowable is for our state, which is Virginia.
A:
According to the region B fee schedule, the allowable for code K-0628 for 2006 is $24.22 per insert. Please note effective July 1, 2006, Virginia will be under the jurisdiction of Region C.
Q: We received a script from a pain treatment center for a TLSO (L-0462). We asked the patient if they had a back brace before and they said no. We fit the patient and filed the claim. The claim was denied due to the fact the patient had a brace in the last five years. Can we appeal this?
A:
If you can obtain additional documentation showing the old brace is no longer adequate due to wear and tear, because the patient had a weight gain/loss and the brace no longer fits, or if it was damaged or stolen, etc., you can appeal your denial with this additional documentation, and Medicare will consider paying for another brace if the information submitted supports the need for another brace. When receiving a denial for same or similar equipment (CO-57), you must send in your appeal within 120 days of the denial date on the EOB.
We invite readers to ask questions regarding billing, collections, or related subjects. Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade. For more information,contact lisa@opedge.com
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc. 
Table Of Contents - June 2006
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