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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. Count on 'Got FAQs?'to help you navigate the complex world of O&P claims and billing.
Q:
I heard a rumor that Medicare will be denying all addition codes associated with L-1845 as of July 1,2008. Do you know if this is accurate?
A:
According to the Future Local Coverage Determination (LCD) published by the Centers for Medicare & Medicaid Services (CMS), the following addition codes are eligible for separate payment when billed with L-1845 as the base code: L-2385, L-2395, L-2397, and L-2795. Additional codes may be payable separately if they are provided with the related base code orthosis and the addition is considered medically necessary. Additional codes considered not medically necessary when billed in conjunction with L-1845 are L-2405, L-2415, L-2492, and L-2785.
Q:
We recently discovered a box of old claims that were never submitted to Medicare by our billing staff. If we submit these claims to Medicare, will they deny as timely? What date of service can we submit?
A:
Claims for services provided between October 1,2006, and September 30,2007, must be submitted by December 31,2008. Unfortunately, if your date of service is prior to October 1,2006, your claim would be denied as timely. However, you may still want to file your claims that would deny as timely. Medicare will not make a payment for a timely claim, but you can bill the beneficiary for the 20 percent coinsurance and any unmet part of the deductible.
Q:
Our patients sign a form stating that they will be responsible if Medicare denies their claim for same or similar equipment which the patient did not inform us about. Can we bill the patient since we have this form on file? My practitioner says we can; however, I am not so sure. Is the form we use the same as an ABN [advance beneficiary notice]?
A:
Suppliers must use the Office of Management and Budget (OMB) -approved ABN form CMS-R-131, which can be found online at
www.cms.hhs.gov/CMSForms/list.asp
. For an ABN to be considered acceptable, it must clearly identify the particular item and state that the supplier believes Medicare will likely deny payment for it. It also must state the supplier's reason they believe Medicare will likely deny payment for the item or service.
Q:
I submitted a claim to Medicare using a place-of-service (POS) code 12. My claim denied due to the incorrect POS. The patient lives in a skilled nursing facility (SNF). Do you know what code I need to use?
A:
If the patient resides in a SNF, the place-of-service code is 31. For a complete list of POS codes, go to
www.adminastar.com/Providers/DMERC/medicalpolicy/chapters/Chapter11.htm
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 profession 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
Table Of Contents - July 2008
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