October 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: I am an O&P provider who has been billing claims
to Medicare for AFO braces and Velcro® closures. I used the
L-2999 for the Velcro closures, and it was denied as not
I have accepted this denial for some time now, but recently found out from another provider that they have been billing the same codes/items and received payment. What am I doing wrong?
A: When billing miscellaneous codes such as L-2999, L-3999, etc. to Medicare, you need to submit the claim with the pertinent information in the additional documentation field (HAO field). The claim for code L-2999 must include a narrative description of the item, the brand name and model name/number of the item, and a statement defining the medical necessity of the item for the particular patient. For example, a complete description would be heel puller straps attached to AFO or 1/4 inch of Dacron-backed Velcro for patients AFO. By doing this, you are giving Medicare the necessary documentation required to review and process the claim accordingly.
Q: I am a provider located in Region C, and recently I have been receiving numerous denials on osteoarthritis unloader braces and knee braces L-1844, L-1858, etc. Also, I have noticed a major delay in payment, if any is made. Is there something I can do to prevent the delay or avoid receiving denials on these claims?
A: According to Region C, they recently have been experiencing an abundance of claims being billed for knee braces. They have been denying these claims for C0-16 (lacking information needed to process claim) or CO-50 (not medically necessary). Sometimes a standard audit letter is issued to the provider requesting a delivery ticket, referring physicians notes, and an AOB signed by the patient. If you have all of the above-requested information on file, you should send it hardcopy with the initial submission of the claim. This will help avoid the standard audit letter being sent out, which creates the delay in reimbursement of your claim.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.