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-----Original Message-----
From: [E-mail Address Removed] [mailto:[E-mail Address Removed]]
Sent: Monday, March 23, 2015 06:32 PM
To: [E-mail Address Removed]
Subject: Medicare and MPKs



Has anyone been successful in getting paid by Medicare for a Microprocessor Controlled Knee without going thru the entire spectrum of the appeal process?

Replies follow

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5-10 MPK's per year for last 5 years w no audits on front or back end.

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Yes, we are. Some do go through audits but we are getting paid for both MPK and MPF's.

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Please share responses.

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Not recently Ted....in the middle of another one now post pre-payment review....
grrrrr.

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Yes my last mpk with Medicare was paid in 3weeks no appeals needed. But rest assure I have a mountain of documentation if needed

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We got paid last May in full for a C leg. Had great documentation, but it wasn't audited. Mc + AARP

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Gotta love our improved healthcare! Yes, I billed and was paid for 3 Symbionic Legs last year through Medicare. Sent my supporting documentation and paid 45 days later.

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We've had one prosthesis denied... Dumbass MD and our oversight and learning curve. That's my only denial, and that is two years old this may. I am practicing at 100% coverage on first round of request of supporting/additional information.

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I have, and it was based on the physicians chart notes detailing a solid k3 functional level.....or so I think. I got Paid and they haven't taken it back. I have another new ak in the pipeline that is headed that direction but won't be ready for the definitive for a couple more months.

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I'm in region C and we have never had a MPK audited. We are very picky about who gets them and probably do around 8-10 a year. So maybe we don't do enough to get noticed.

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In my billing experience, in the last 3 years- no I have not had any microprocessors knees covered by medicare w/out going through the appeals process. In fact my former O&P firm hired legal counsel for the appeals. With the process "backed up" for at least 24 months- I don't know if they will ever get paid.


Basically, Medicare's justification is- if they are on Medicare-they have no need for a microprocessor knee. Not that I agree with that- but we are forced to bill according to what we know the insurance will cover, unless the patient is willing to pay for item.
I hope this helps.

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Im in region D. But they audit most all of them now.

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Ted can you post some answer's? ..thx

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