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Got FAQs?
By Lisa Lake-Salmon Denials are difficult to identify and time consuming to appeal. With mandatory accreditation, aging technology, and increased billing errors, running an O&P shop gets more complicated each year. Count on "Got FAQs?" to help keep your shop in top shape!
 Q: A colleague of mine stated that even though I am licensed in my state to practice, I still have to become accredited. Is this true? Where can I find a list of companies that are approved to do accreditation?
A:
Licensure is a state-by-state requirement. Licensure and/or certification is granted to a specific individual within a particular division of the company. Accreditation is a national standard that covers the entire organizations level of excellence. There are ten accreditation agencies that have been approved by the Centers for Medicare & Medicaid Services (CMS). These agencies can be found at
www.cms.hhs.gov/CompetitiveAcqforDMEPOS
Q: Will I have to use my NPI (national provider identifier) number when submitting claims to any other insurance companies, or is it just for Medicare? Also do I use the referring physicians UPIN (unique physician identification number), or does he have an NPI number? I want to make sure our claims do not get denied for using an incorrect provider number. I am sure there are other providers who find all these changes confusing.
A:
All insurance companies, effective May 23, 2007, will require you to submit claims with your NPI number only, which is a unique identification number for healthcare providers. You will also need the referring physicians NPI number to bill your claim. Unlike physicians UPIN numbers, there is no central list to look up a physicians NPI number at the present time. I suggest providers start requesting their referring physicians NPI numbers, so you may begin updating your database.
Q: I received a CO-16 denial for L-0100, which I have used before and have always been paid. Does Medicare no longer pay for this code?
A:
Effective January 1, 2007, L-0100 (cranial orthosis (helmet), with or without soft interface, molded to patient model) has been changed to either A-8002 or A-8003. You will need to see which code best describes the orthosis you are giving your patient. Also note that L-0110 (cranial orthosis (helmet), with or without soft interface, non-molded) has been changed to A-8000 or A-8001.
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 - May 2007
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