November 2004 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 have recently received numerous denials when billing L-0500 and have always been paid for this in the past. Do you know why I was denied?
A: Effective for dates of service on or after April 1, 2004, L-0500 is no longer a valid code. It has been replaced with K-0634.
Q: If there is a Medicare allowable, can a provider charge for an item when the manufacturer does not charge for it separately?
A: The provider cannot bill Medicare when the manufacturer's invoice does not reflect a separate charge for the item in question.
Q: I received a denial from a commercial insurance carrier stating authorization was needed. Will Medicare, which is secondary, pay for this claim?
A: Unfortunately, if you do not follow the proper procedures with the patient's primary insurance in obtaining authorization, Medicare will not pay for your claim.
We invite readers to ask any questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact:email@example.com.
Acc-Q-Data provides billing, collections and practice management software serving the O&P industry nationwide for over a decade.
Lisa Lake-Salmon is Executive Vice President of Acc-Q-Data Inc.