Got FAQs?
By Lisa Lake-Salmon .jpg) Denials are difficult to identify and
time consuming to appeal. With competitive bidding, mandatory
accreditation, aging technology, and increased billing errors,
running an O&P shop gets more complicated each
year.
Q: I have searched everywhere for a diabetic
shoe form that I need to have filled out by the physician. Since
DMERC continuously changes its website, I cannot find this
anywhere. Please help while there is still hair left on my
head.
A: The form you need is called " Statement of Certifying Physician for Therapeutic
Shoes"
Q: I recently billed Medicare for services that
took place in the office using place-of-service code 11. My claims
were denied with a denial code of CO-16. When I contacted Medicare,
they informed me it was due to an incorrect place-of-service code.
What did I do wrong and how can I correct this with Medicare? I was
also informed that I now need to put a specific place-of-service
code for services provided at a prison. Do you know the code I
would use?
A: Anytime you bill Medicare for services that
the patient can take home, the item and/or benefits from the
services at home must be billed with a place-of-service code 12.
The place-of-service code 11 is used more for procedures that are
done in the office and/or hospital services. Since your claim was
denied for CO-16 (lacks information for adjudication), you will
need to submit a new claim to Medicare with the corrected
information. Effective January 2008, if you provide services to a
patient in a prison or correctional facility, the place-of-service
code will be 09.
Q: I have received multiple denials CO-50 (not
medically necessary) when billing L-5980 along with L-5540. I
received payment on L-5540, but they are denying the L-5980, and I
cannot figure out why.
A: The L-5980, Flex-Foot® system, is not
meant to be used with the L-5540, below-the-knee prothesis with a
SACH foot interface. The coverage is according to functional
levels, which for L-5980 is level 3 and for L-5540 is level 1.
Q: I am a provider in Illinois. I received a
denial from Region B stating the claim was not covered by this
payer or contractor. I was told that if I submit my claim to Region
B, they would forward the claim to the correct DMERC region the
patient is listed with. Is this not true?
A: According to National Government Services
(NGS), the patient DMEPOS jurisdiction is based on the
beneficiary's address on file with the Social Security
Administration (SSA). Providers should verify that the address they
have on file for the beneficiary is the same address listed with
SSA. You may also want to purchase real-time patient-eligibility
software to verify all of your patient benefits.
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 
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