July 2003 Issue
The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.
Q: As an O&P provider, I receive many requests to deliver items to a patient while they are in the hospital and I find I have a hard time being paid for these services by Medicare. Please advise me how to properly bill Medicare for these services.
A: According to DMEPOS, you may deliver items to a patient during an inpatient stay at a hospital as long as the delivery date is within two days prior to discharge and the item is needed for fitting and training purposes. When billing Medicare, your date of service should be the patient's discharge date instead of date of delivery. Your place of service should either be 11 (office) or 12 (home). You should have all the proper documentation in the patient file to support this information.
Q: I have recently received multiple denials from Medicare due to diagnosis codes not being valid. Can you please help me understand this, since the codes are listed in the current ICD-9 code books?
A: Effective April 1, 2003, the DMERCS have implemented new edits related to diagnosis codes.
ICD-9 codes contain three, four, or five digits. If a code which you may have used in the past has either a fourth or fifth digit which further describes the diagnosis, then the three-digit code will be denied. Your claim must be resubmitted with the proper fourth or fifth digit in order for your claim to be paid.
We encourage readers to write in and ask any questions you have regarding billing, collections, or any other related information.
Acc-Q-Data provides billing, collections and practice management software serving the O&P industry nationwide for over a decade. To send your questions or for information, contact:firstname.lastname@example.org.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.