Got FAQs?

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By Lisa Lake-Salmon

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 recently received a denial from Medicare for K-0670 and do not understand why. I used this code in December and was paid for it.

A: Effective January 1, 2006, procedure code K-0670 (addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control, stance phase only) is no longer valid. For dates of service after January 1, 2006, L-5858 should be used.

Q: Some of my patients cannot afford the 20-percent Medicare co-pay. Is it okay for me just to write these charges off?

A: The law requires the provider to make an effort to collect the 20-percent co-insurance payment. The supplier must keep evidence on file of the attempt to collect this from either the patient or the secondary insurance. The supplier has an option of waiving the co-insurance in case of hardship; however, a supplier cannot routinely waive the 20-percent co-insurance payment for every patient.

Q: We fit a HKAFO for a Medicare patient, and now, due to weight loss, he needs the thigh cuff replaced. How do we bill that? L-2999? Do we need a new script or do we add language in the narrative?

A: Did you simply replace the cuff or were there repairs, labor, or other materials involved? If the cuff was replaced and there were no other repairs, you would bill with L-2999 along with the script and LMN stating the patient had volume changes and what caused these changes in the limb. If there were repairs, you would use the L-4205 RP RT/LT (repair of orthotic device, labor component) in addition to the L-4210 RP RT/LT (repair or replace minor parts, orthotic device)

We invite readers to ask questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact:lisa@opedge.com
Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for more than a decade. For more information contact lsalmon@acc-q-data.com

Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc.