Billing and Collections Q&A
By Lisa Lake-Salmon
Running an O&P shop gets more complicated each
year. Whether you have Medicare billing or reimbursement questions,
a Medicare policy question, or you just need help finding a
resource, count on Got FAQs? to help you get the answers you
need.
Q: I have looked everywhere and I am unable to
locate a website or list that I can use to verify my referring
physician's NPI number. Are you aware of any such site that may be
available to providers?
A: There are a few resources that I know of
that are available to providers. Try visiting www.hmedata.com/npi.asp, or ppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. A
downloadable file is also available at nppesdata.cms.hhs.gov/cms_NPI_files.html
Q: I recently moved to another location and was
told by Medicare that I need to fill out another provider
enrollment form. Could this be possible? I am only changing my
address. Is there a simple form or letter I can send to them to do
this?
A: According to the Medicare Supplier Standard
No. 2, suppliers are required to inform the National Supplier
Clearinghouse (NSC) of any location change within 30 days. You will
need to fill out certain sections of a CMS-855S application. To
change an address, you only need to fill out sections 1C, 3, and 4
(only complete the sections that pertain to the data you are
changing), section 13, and section 15 if you are the authorized
official for you practice. If you have any questions completing
this form, you may contact me directly.
Q: Can a brace (L-2036 in our case) be billed
to Medicare while the patient is still in the hospital, with no
talk of discharge planning since the patient has been in the
hospital for more than 100 days? We understand Medicare Part A
expires and Part B becomes eligible for our billing purposes. If
so, how do we bill, for example, place of service code and any
special modifiers?
A: When billing your claim to DMERC, you will
use the RT or LT modifier, and your place of service will be 21
(inpatient hospital). For a complete list of place of service (POS)
codes, visit www.cms.hhs.gov/placeofservicecodes/downloads/posdatabase.pdf
Q: I have a patient who requires some repairs
to his orthosis, and since the patient is unable to come into my
office, I need to travel roughly 55 miles to the patient's home.
Does Medicare reimburse for a practitioner's travel time and or
expenses?
A: In a perfect world Medicare would recognize
the growing expenses of an O&P provider. Unfortunately in this
world, travel time is included in the reimbursement of parts
(L-4210) and labor (L-4205) and may not be paid separately.
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 - November 2007
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