Got FAQs?

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By Lisa Lake-Salmon
Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. Count on "Got FAQs?" to help get your claims back on track. This month's column tackles your questions about Medicare denials due to invalid place of service, time limits for filing claims, addition codes for custom-fabricated knee braces, and more.

Q: We provided a patient with an L-1832 and received a denial from Medicare stating the patient already had the same or similar device. After many hours of research, we found out the patient received the same brace only 14 months prior. Since Medicare guidelines state the useful lifetime on this brace is two years, it will not reimburse us for this. Do you know a way we could verify if a patient ever received a particular brace in the past so we can avoid this happening to us again?

A: You did not mention if you had the patient sign an ABN form. If not, you cannot bill the patient for the brace. As a Region C provider, you may contact your Durable Medical Equipment Administrative Contractor (DME MAC) customer service at 866.270.4909 to find out if the patient had a same or similar item in the past.

Q: I am a new billing manager for an O&P practice located in Region D. I have received many denials for CO-58 (treatment was rendered in an inappropriate or invalid place of service). We provided the patient with the brace in our office, so I used place of service 11 (office). Am I missing something?

A: When submitting a claim for a DMEPOS item (a brace would be considered this), the place of service is considered to be the place where the patient will primarily use the item (brace). Therefore, in your situation, the place of service would be 12 (home). You can resubmit your claims to Medicare with the correct POS 12, and they should be processed accordingly.

Q: We recently found a large number of claims that were never filed by our former billing manager. The claims are from 2007, 2008, and 2009. How far back can we bill Medicare for these claims? If we cannot bill Medicare, is there anyone we can bill, or do we have to take the loss? My partner and I could not figure out how we were making so little money-we should have paid more attention. Any help would be greatly appreciated since this is a lot of possible lost revenue.

A: You have until December 31, 2009, to file claims to Medicare for dates of service October 1, 2007, through September 30, 2008. For claims with dates of service October 1, 2008 through September 30, 2009, you have until December 31, 2010. If you receive any denials from Medicare labeled CO-29 (the time limit for filing expired) you may bill the beneficiary for 20 percent of the allowed amount.

Q: Which addition codes does Medicare reimburse for when billing for a custom-fabricated knee brace (L-1840 or L-1844)? We fit a lot of these braces and feel our billing staff may not be billing for all the additions we are providing. When we look at what it costs to make these braces, we are not making much when we bill Medicare.

A: When billing for L-1840, addition codes that are eligible for separate payment are L-2385, L-2390, L-2395, L-2397, L-2405, L-2415, L-2425, L-2430, L-2492, L-2785, and L-2795. When billing for L-1844, addition codes that are eligible for separate payment are L-2385, L-2390, L-2395, L-2397, L-2405, L-2492, and L-2785.

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