April 2005 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: Can you please explain what the remark code is on
the Medicare remittance advice?
A: The remark code is a code on the left side of the claim data that informs you of that particular claims adjustment, denial, or payment reason. Do not forget to look at the remark code (i.e., M51 = missing/incomplete/invalid procedure code) before calling Medicare to inquire about the claim. This could save you precious time!
Q: Are suppliers required to request an appeal for a non-assigned claim?
A: No. Under mandatory submission of claims, a supplier has fulfilled his/her obligation by filing a non-assigned claim. The beneficiary or his/her authorized representative (which may be the supplier if requested by the beneficiary) must request the appeal on a non-assigned claim.
Q: I received a denial on a thoracic-lumbar orthosis as not medically necessary, and I am not sure why. When does Medicare consider this item medically necessary?
A: According to DMERC, this type of orthosis is covered when it is ordered to reduce pain by restricting movement of the trunk; or to assist healing following an injury to the spine or related soft tissue; or to support weak spinal muscles and/or a deformed spine; or to facilitate healing following a surgical procedure on the spine or related soft tissue.
We invite readers to ask any questions you may have regarding billing, collections, or any other information. To sendyour questions or for more information, contact:firstname.lastname@example.org
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, Acc-Q-Data, Inc.