Billing and Collections Q&A
By Lisa Lake-Salmon Billing is complicated, and denials are difficult to
identify and time consuming to appeal. Don't let these issues slow
down your O&P shop. Turn to 'Got FAQs?' to help keep your
practice on track.
Q: I submitted a claim to Medicare for a knee
CPM and thought my patient had met all the coverage criteria. My
claim was denied, and I was told it was missing documentation. Can
you help?
A: In order for a knee CPM to be covered, the
patient's diagnosis must be V-4365 (total knee replacement). The
knee CPM must be put on the patient within two days of the date of
surgery. The CPM will be covered for 21 days only. If you are
submitting your claim electronically, then you must state the
following in the additional documentation:
- Date of surgery.
- Date CPM was placed on the patient.
- Date of discharge from the hospital.
Q: I have a non-diabetic patient whose
physician prescribed an AFO brace (L-1960). Will Medicare cover
this?
A: According to DMERC, the purpose of a brace
is to support a weak or deformed body member or to restrict or
eliminate motion in a diseased or injured part of the body. When an
AFO for an ambulatory patient and any related addition is used
solely for the treatment of edema and/or for the prevention or
treatment of a pressure ulcer, it will be denied as non-covered.
L-1960 is covered for ambulatory patients with weakness or
deformity of the foot and ankle who require stabilization for
medical reasons and have the potential to benefit functionally.
Q: I am a certified pedorthist from Pismo
Beach, California, and recently made a custom AFO for a patient.
Before I was able to fit the patient with the AFO, he passed away.
Can I still bill for this?
A: If a custom-made item was ordered but not
furnished because the individual died or the order was canceled by
the beneficiary, payment can be made based on the supplier's
expenses. In these cases, the expense is considered incurred on the
date the beneficiary died or the date the item was canceled. You
can learn more at www.cms.hhs.gov/manuals/downloads/bp102c15.pdf,
Medicare Benefit Policy Manual, Chapter 15, Section 20.3.
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 - December 2007
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