Got FAQs?

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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 a new provider of diabetic shoes and inserts and would like to know how many of each item is a patient allowed per year.

A: Patients who meet the coverage criteria may receive the following each calendar year: one pair of custom-molded shoes (A-5501) or one pair of depth shoes (A-5500). One pair of inserts is included with the A-5501, and the patient may get two additional pairs of inserts (A-5509 or A-5511). A-5500 does not include a pair of inserts; therefore, you may provide the patient with three pairs of inserts.

Q: I received an overpayment request that I disagree with. If I appeal the request, do I still have to refund the money to Medicare?

A: Yes. A request for an appeal will not alter the overpayment request. If an appeal results in a partially or fully favorable decision, an appropriate refund will be made to the provider. Any overpayment due to Medicare should be made within 30 days after the first demand letter.

Q: I heard that the K-Codes for the gel liners have been changed back to L-Codes. Is this true? If so, do you know the codes and when they become effective?

A: Effective January 1, 2004, the K-Codes for gel liners are once again L-Codes: K-0556 has been changed to L-5673; K-0557 has been changed to L-5679; K-0558 has been changed to L-5681; and K-0559 has been changed to L-5683. However, the description for the codes remains the same.

We invite readers to ask any questions you have regarding billing, collections, or any other related information. To send your questions or for more information, contact:lisa@westernmediallc.com

Acc-Q-Data provides billing, collections, and practice management software and has been serving the O&P industry nationwide for over a decade.