July 2006 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 a provider of service in Region C and was told by one of my billing staff that Palmetto GBA will no longer accept reviews on claims. We have a claim that recently was denied, and we are not sure what we should do.
A: Effective January 1, 2006, any redeterminations (formerly known as reviews) should be sent to a Qualified Independent Contractor (QIC). The address for the QIC is: Q2A Administrators, PO Box 100213, Columbia, SC 29202-0213.
Q: I received my Medicare provider number six months ago, and now a colleague tells me that there is another provider number I have to apply for. He said it is called an NPI number. I am not sure how I go about doing this. Do I need to fill out a new Medicare application?
A: Beginning May 23, 2007, DMEPOS suppliers must obtain and begin using an NPI. For more information about the NPI number, go to www.cms.hhs.gov/NationalProvIdentStand. You also can apply for an NPI number online at www.nppes.cms.hhs.gov
Q: I received a denial from BCBS of California for K-0647 and when I called to see why my claim was denied, they stated the procedure code was no longer valid. I tried to find the replacement code for this and can't find it anywhere .
A: According to the level II HCPCS for 2006, procedure code K-0647 was replaced by L-0638.
We invite readers to ask questions regarding billing, collections, or related subjects. For more information, contact firstname.lastname@example.org . Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.