Got FAQs?

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By Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, and increased billing errors, running an O&P shop gets more complicated each year. Count on Got FAQs?' to help you sort through the complexities.

Q: I have been receiving my Medicare payments from Region C electronically for over two years. Recently they just stopped, and I am now receiving my checks by mail again. Do you know why it would just stop? Who do I need to contact in order to receive my funds electronically again?

A: Effective June 1, 2007, CIGNA Government Services took over for Region C. In order to continue receiving your funds electronically, you need to fill out a new EFT form. This form can be found at www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf

Q: If I am providing a patient with a diabetic custom-molded shoe (A-5501), how many additional pairs of inserts can I bill for?

A: When billing for A-5501 (diabetic custom-molded shoe), you are allowed to bill for two additional pairs of inserts (A-5512) or (A-5513), which is equal to four units. When billing the A-5501, one pair of inserts is included with these shoes.

Q: I have been trying to get a problem with Medicare resolved for over six months and have been getting nowhere! Is there someone I can contact who could possibly help me resolve my issue in my Region?

A: Each state has an ombudsman who can help providers investigate complaints, report findings, and facilitate problem solving. The ombudsman for the state of Tennessee is Ronja F. Roland, who can be reached by phone at 615.941.8797, or by mail at:

Ronja F. Roland
5341 Mt.View Road, Suite 122
Antioch, TN 37013

Each DMERC region has a provider manual on its website, which lists the ombudsman for each state.

Lisa Lake-Salmon is the executive vice president of ACC-Q Data, which provides billing, collections, and practice management software and has been serving the O&P industry for more than a decade. We invite readers to write in and ask any questions they have regarding billing, collections, or related subjects. For more information, contact lisa@opedge.com