September 2008 Issue
Running an O&P practice is complicated, and when you have questions, "Got FAQs?" has the answers that can keep your practice running smoothly. This month's column tackles your questions concerning acknowledgements, authorized signatures, claim appeals, and changing L-Codes.
Q: We recently had a patient who received items from us (toe fillers, carbon plate, etc.). The patient signed for the delivery of these items; however, we failed to put the right quantity of each item on the delivery ticket. What does Medicare require on the delivery acknowledgement in terms of codes, description, pricing, and quantity?
A: According to Chapter 3 of the Region C supplier manual, an example of proof of delivery to a beneficiary should include the following information: (1) the patients name; (2) the quantity delivered for each item; (3) a detailed description of each item being delivered; (4) the brand name; and (5) the serial number (if applicable), plus the date the patient received the items, along with his or her signature.
Q: We are waiting for a patient s documentation to arrive from a physician's office, and I was wondering who in the physicians office is allowed to sign the paperwork or fill out a written order?
A: A physician assistant, nurse practitioner, or a clinical nurse specialist may document medical necessity or complete an order, provided that he or she meets the practitioner requirements as stated in Chapter 15 of the Benefit Policy Manual. The services performed must be within the scope of practice for these professionals, as defined by their state, and they must be treating the patient for the condition for which the item is needed.
Q: We received our first CO-50 (not medically necessary) denial from Medicare, and I am not sure what would be our next step in order to appeal Medicare's decision on this claim. Whom do we contact to see if Medicare will review our claim again?
A: The first level of the appeals process is called a redetermination. Requests for a redetermination must be submitted in writing. You must fill out the redetermination request form and mail it to CIGNA Government Services, DME MAC Jurisdiction C, PO Box 20009, Nashville, Tennessee 37202. The request form can be found at: www.cignagovernmentservices.com/jc/forms/pdf/JC_redetermination_form.pdf
Q: I am trying to bill for an L-3910 to Blue Cross Blue Shield of California, and I was told it is no longer a valid procedure code. Do you know if this code has changed? If so, what is the new code?
A: As of January 1,2008, L-3910 (WHFO, Swanson Design, prefabricated, includes fitting and adjustments) is no longer a valid code. The code was replaced by L-3931.
Lisa Lake-Salmon is the executive vice president ofACC-Q-Data, which provides billing, collections, and practice management software. She has been serving the O&P profession for more than a decade. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, e-mail: