Got FAQs?
By Lisa Lake-Salmon 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: What is the Medicare rule on a leg that was built for
a patient who weighs over 300 pounds? We ordered custom parts to
accommodate her. We have had a hard time getting her in for a
fitting, and we finally got her in to finish the leg. Now she will
not come back and pick up the leg. Every time we call her, she
gives us a different excuse. We offered to take the leg to her
house, and she makes an appointment but never keeps it. This has
been going on since July of 2007. Is there anything we can bill to
Medicare?
 A: If a custom-made item was ordered but not
furnished due to the individual dying or the order being 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 cancelled. You
can go to www.cms.hhs.gov/manuals/downloads/bp102c15.pdf
or the Medicare Benefit Policy Manual, Chapter 15, Section
20.3, for more information.
Q: Our office was recently audited by a hospital that we
have a contract with. During the audit, the hospital asked why we
did not have a fitting charge for the off-the-shelf orthosis. Is
there a fitting charge for these orthoses at the hospital in
addition to the reimbursement for the item being
delivered?
A: According to Medicare evaluation of the patient, measurement
and/or casting and fitting of the orthosis is included in the
allowance for the orthosis (as stated in ankle-foot/knee-ankle-foot
orthosis chapter of the Medicare Benefit Policy Manual).
Because you have a stipulating contract with this individual
hospital, you may be able to seek reimbursement based on your
contract with them. I recommend you check your contract and fee
schedule with the hospital.
Q: I am licensed in my state as a certified prosthetist.
Do I still have to become accredited? If so, do you have a company
that you recommend for accreditation, or where can I find a list of
accrediting agencies?
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 will become a
required national standard that covers the entire organizations
level of excellence. There are 11 accreditation agencies that have
been approved by CMS. They can be found at www.cms.hhs.gov/CompetitiveAcqforDMEPOS.
Q: I recently have been unable to transmit claims to
Medicare. We are receiving front-end rejections stating there is an
error in the NPI crosswalk. I contacted Medicare and I was told
there is a discrepancy between our NPI number and our legacy
provider number. I am not sure what I am supposed to do at this
point. I would greatly appreciate any assistance you can
provide.
A: When you applied for your NPI number, you listed yourself as
an "individual" and your legacy provider number has you listed as a
"group/organization." Since the information does not match, both of
your claims will be rejected on the front end. In this case you
will have to apply for a new NPI number. You may do so at https://nppes.cms.hhs.gov/NPPES/Welcome.do
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 - January 2008
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