Got FAQs?
By Lisa Lake-Salmon .jpg) Claim denials can become the bane of
your existence if you're not current on Medicare rules and
regulations. Who has time to keep up with all of that, anyway?
Count on "Got FAQs" to keep you informed and help you and your
staff better understand billing procedures and reimbursement
strategies.
Q: I received a denial from Blue Cross Blue
Shield (BCBS) of Michigan stating my claim cannot be processed as
billed. I submitted L-1906 RT LT. I do not understand why this
would deny since I receive payment from Medicare on this all the
time. Are you familiar with this insurance company?
A: Unlike DMERC, when billing BCBS of Michigan
you must submit your claim as two separate line items. If you bill
L-1906 RT as one line item, then bill L-1906 LT on the next claim
line. Given the information you provided, this should get your
claim paid.
Q: Our office received a prescription for a
TLSO (L-0462). We asked the patient if he previously received a
back brace, and the patient said no. The patient was fitted, and we
filed the claim to Medicare. We received a CO-57 denial, same or
similar equipment. 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 or loss and the brace no
longer fits, because the brace was damaged or stolen, etc., you can
appeal your denial with this additional documentation, and Medicare
will consider paying for another brace if it feels the information
submitted deems it medically necessary. When receiving a denial
code of CO-57 from DMERC, you must file your appeal within 120 days
of the denial date on the EOB.
Q: I am trying to submit a claim electronically
to Medicare for L-3914. I keep receiving front-end rejections and
cannot seem to get this claim through to Medicare.
A: Effective January 1, 2007, L-3914 is no
longer a valid code. It has been replaced by L-3908. Resubmit your
claim with L-3908 and the appropriate RT or LT modifier, and this
should resolve your issue.
We invite readers to write in and ask any questions they may
have regarding billing, collections, or related subjects. For more
information, contact lisa@opedge.com
Lisa Lake-Salmon is the executive vice-president of
Accu-Q-Data, which has provided billing, collections, and practice
management software serving the O&P industry nationwide for
more than a decade. 
Table Of Contents - February 2007
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