Denials are difficult to identify and time-consuming to appeal. Count on "Got FAQs?" to help you sort through the complexities associated with O&P billing. This month's column addresses your questions about Medicare Change in Products and Services, submitting claims to TRICARE, and new rates for L-7520.
Q: I recently took over ownership of a facility located in Region C, and we have started receiving denials stating, "supplier not licensed to provide these services." I am now being told that our office did not properly list the products and services we provide on our application. The person who filled out the application is no longer here. I am not sure how I should proceed or what I need to do first.
A: You will need to update the 855S Medicare Application and fill out the sections required for Change in Products or Services. For changes in products and services (submit accreditation if applicable) complete section 1C, 2 (complete 2A1 and those data elements that are changing), 3, 13, either 15 if you are the authorized official or 16 if you are the delegated official, and 6 for the signer if that authorized or delegated official has not been established for this durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier. To access complete instructions, visit www.oandp.com/link/193
Q: I work for a provider who recently started submitting claims to TRICARE. I have received some denials and was told to look at TRICARE's policy manual to review its medical policies and medical necessity. I have been unable to find this information. Can you tell me where I can find this? I was told we should add a blanket diagnosis code to each patient claim for a particular device we provide. I am not sure if I should be adding this to the claim or not. I would greatly appreciate your assistance as I do not want to do anything that could cause my provider to get into trouble.
A: You can go to the TRICARE home page for rates and reimbursement fees at www.tricare.mil/tma/default.aspx. You can review all TRICARE's Policy Manuals at manuals.tricare.osd.mil. Regarding the addition of blanket diagnosis codes, my contact at TRICARE stated that it "could be considered a violation of 32 Code of Federal Regulations (CFR) Chapter 1 Section 199.9 (c)(7)." To find more information about this federal regulation, visit www.oandp.com/link/194
Q: We are prosthetic providers in Oregon and frequently repair prosthetic devices. I was told by a colleague of mine that our rate of $40 per 15 minutes for L-7520 (repair prosthetic device, labor component, per 15 minutes) is below what Medicare allows for our state. My colleague claims he read somewhere that Medicare has increased the allowable labor codes this year. Is my colleague correct?
A: Your colleague is absolutely correct in what he read. Medicare has increased the labor payment per 15 minutes for L-7520 by 1.7 percent effective for dates of service on or after January 1, 2013. An article publishing this information was released on December 7, 2012, titled "Calendar Year (CY) 2013 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule." To read the article, visit www.oandp.com/link/195
Lisa Lake-Salmon is the president of Acc-Q-Data, which provides billing, collections, and practice management software. She 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. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact or visit www.acc-q-data.com
