Got FAQs?
By Lisa Lake-Salmon .jpg) Having trouble keeping up with the new Medicare 2007 rules and
regulations? Overwhelmed by the numerous code changes? Count on
"Got FAQs" to help you understand the full aspect of billing
guidelines and procedures, which will effectively increase your
reimbursement.
Q: A colleague of mine stated that Medicare
will not accept my claims in the future without an NPI (National
Provider Identifier) number. Is this true? How do I apply for one,
and when do I need to start using it?
A: Beginning May 23, 2007, all DMEPOS suppliers
must begin using an NPI number when submitting claims to the
DMERCs. I urge you to apply for your NPI number as soon as
possible, as time is running out. You may fill out your application
online at https://nppes.cms.hhs.gov
Q: I am a contract specialist for a large
O&P facility, and I have a question regarding NPI numbers. I
noticed in the December 2006 issue of The O&P EDGE
your answer about multiple locations. Since we are required to have
a Medicare number for each of our locations, are we required to
have an NPI number for each location with a Medicare
number?
A: According to DMERC, if you are a sole
proprietor of your practice, it is not necessary to obtain an NPI
number for each location. If a Medicare supplier is a sole
proprietor, the supplier is eligible for only one NPI number
regardless of the number of locations it may have. If you are not a
sole proprietor of your practice, then it is necessary to obtain an
NPI number for each location. If your company is a corporation and
has multiple owners, then it is necessary to obtain an NPI number
for each of your locations.
Q: I recently received a denial from Region B
on a claim for a preparatory BK proshesis (L-5540, L-5620, L-5940,
L-5910, L-5647, L-5679, L-5972, L-5986, L-8420, L-8470, L-8440).
All codes were paid except L-5647, which was denied as not
medically necessary. Is there anything I can do to get this code
paid? I called Medicare, and the claim representative told me
"no."
A: In the December 2006 advisory, Medicare
stated that the coding guidelines for L-5647 and L-5652 are being
revised as follows: "A suction valve (L-5647, L-5652) is rarely
needed when a suspension locking mechanism is being used. If both
are provided, there should be documentation in the supplier's
records that describes the medical necessity of each for the
specific patient." I suggest you submit your claim for review with
documentation supporting the need for L-5679 (gel liners) in
conjunction with L-5647 (suction socket), as it is now considered
acceptable to use a suction socket as a means of suspension of the
prosthesis and a non-locking gel liner as an interface between the
limb and the prosthetic socket.
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
Acc-Q-Data, which provides billing, collections, and practice
management software and has been serving the O&P industry for
more than a decade. 
Table Of Contents - April 2007
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