Got FAQs

By Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, increased billing errors, running an O&P shop sure can be a challenge!

Q:  I am an O&P practitioner in the state of New Jersey and was told by a colleague that competitive bidding will begin sometime this year. Is this true? How will my practice be affected?

A:  The competitive bidding program will begin in 2007 in ten metropolitan statistical areas (MSAs). New Jersey is not one of the initial MSAs. The program will be expanded to include 70 additional MSAs in 2009 and additional areas thereafter. Initially, the program will include only ten DMEPOS product categories; orthotic and prosthetic devices are not included in the initial list. [Editor's note: To see the 2007 MSA list, see "CMS Announces Competitive Bidding Final Rule, First MSAs," The O&P EDGE , May 2007.]

Q:  I am interested in applying for competitive bidding, and I am not sure what I need to do to begin this process.

A:  An authorized official of your company must first fill out an initial registration and obtain a user ID and password. You may do so at applications.cms.hhs.gov . Each supplier must obtain a user ID and password before it can enter a bid into the competitive bidding Internet application. [Editor's note: For more information, visit www.dmecompetitivebid.com ]

Q:  I am a billing manager for a facility in Region A. We provided a patient with a below-knee prosthesis and received payment for all codes except L-5980, which denied as CO-50. I billed codes L-5301, L-5620, L-5637, L-5910, L-5940, L-5629, L-5673, L-5679, L-5671, L-8420, L-8440, L-8470, L-5980, and L-5685. This is the most expensive code, and the practitioner is having a fit! We used modifiers LT K2 and the DX code was 897.0. Is there anything we can do?

A:  According to TriCenturion's medical policy, a Flex-Foot® system (L-5980) is covered for patients whose functional level is three or above. You stated your patient's functional level was two. Coverage may be extended only if there is sufficient clinical documentation of functional need for the technologic or design feature of a given type of foot. This information should be supplied to the DMERC and should be obtained in the physician's file, as well as yours.

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.

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

Table Of Contents - June 2007

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	Five Questions for Preston K. Watts Jr., CPO Face to Face
	ACA Conference Kicks off a Summer of Parity Events Progress on Parity
	Got FAQs Got FAQs?
	Letters to the Editor Letters
	Awareness Starts with You Viewpoint