Billing and Collections Q&A

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By Lisa Lake-Salmon
Lisa Lake-Salmon

Running an O&P practice is complicated. When you receive a denial and don't understand why, count on 'Got FAQs?' to help you find the information you need. This month's column tackles your questions about Arizona-type AFOs, surety bonds, time limits on submitting claims, and more.

Q: I read somewhere that Medicare is requesting refunds from providers in Region C who billed for Arizona AFOs. I have submitted roughly 25 of these claims to Medicare in the past year, and I do not understand why I would have to refund money to Medicare for these claims. I cannot find the original article and would appreciate any clarification you can provide about this.

A: There is an article about the appropriate coding for the Arizona Short, Arizona Tall, Arizona Extended, and similar custom-fabricated braces in the spring 2009 edition of the DME MAC Jurisdiction C Insider. The article states, "The Pricing, Data Analysis, and Coding [PDAC] contractor has recently reviewed the Arizona AFO line of products and determined the appropriate HCPCS [Healthcare Common Procedure Coding System] codes to be used when billing [Medicare] for these and similar items." They are requesting any suppliers who incorrectly coded these items when billing Medicare to submit a voluntary refund to them. The article lists the HCPCS codes that should and should not be used when billing for these items and can be found at www.cignagovernmentservices.com/~2009_insider_spring.pdf. The article is on page 7.

Q: I am looking into a company that can issue the surety bond I am required to obtain. Where I can find a list of these companies?

A: The U.S. Department of Treasury publishes a list of sureties from which a bond can be secured. For purposes of the surety-bond requirement, these sureties are considered authorized. The complete listing may be found at www.fms.treas.gov/c570/c570_a-z.html

Q: Our billing person recently left, and we have found numerous claims that were never filed with insurance companies. I know Medicare has a limit for submitting claims to them. How far back can I can go to submit claims to Medicare? Also, where can I find the form I need in order to have Medicare deposit payments directly into my bank account?

A: Medicare will accept claims for services you provided from October 1, 2007, to September 30, 2008, until December 31, 2009. For services provided October 1, 2008, to September 30, 2009, the claim must be submitted by December 31, 2010. You may find the electronic funds transfer (EFT) agreement at www.cignagovernmentservices.com/jc/forms/index.html

Q: I billed Medicare for a lower-limb prosthesis I provided to a patient who was in a skilled nursing facility (SNF). Medicare Region C paid for all codes except L-5670. Why would they pay for all codes except this? Have you heard of any other providers receiving denials for this code when a patient is in a SNF or otherwise?

A: On April 6, 2009, Cigna Government Services (Region C) issued a statement that L-5670 was accidently left off the SNF Consolidated Billing Coding List for 2009. Its system will be updated on October 5, 2009, during its next quarterly update. If you have any claims for L-5670 with a date of service of January 1, 2009, or later, you may contact Medicare at 866.813.7878 to have your claim reopened and reprocessed for additional payment owed to you. For more information about this, visit www.cignagovernmentservices.com/jc/pubs/news/2009/0409/cope9675.html

Lisa Lake-Salmon is the executive vice president of Acc-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. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact or visit www.acc-q-data.com