June 2011 Issue
Running an O&P practice seems to be getting more complicated every year. When you have a question and can't seem to find the answer you're looking for, count on "Got FAQs?" to help point you in the right direction. This month's column addresses your questions about facility accreditation, vacuum pumps for lower-limb prostheses, surety bonds, and more.
Q: I am the durable medical equipment (DME)/orthotics coordinator for a large orthopedic practice that also has a physician-owned orthopedic hospital. My DME department is currently billing under the physicians and is not accredited as a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) provider. Do you have any advice on who would be the best accreditation body to work with for insurance recognition and also to allow the department to grow?
A: When seeking facility accreditation, you must work with one of the ten deemed accreditation organizations (AOs), which the Centers for Medicare & Medicaid Services (CMS) identified in November 2006. All DMEPOS suppliers need to comply with Section I (Supplier Business Service Requirements) and Section II (Supplier Product-Specific Service Requirements) of the Quality Standards. In addition, suppliers will need to comply with the appendices as needed: Appendix A (Respiratory Equipment, Supplies and Services); Appendix B (Manual Wheelchairs, Power Mobility Devices, and Complex Rehabilitative Wheelchairs and Assistive Technology); and Appendix C (Custom Fabricated and Custom Fitted Orthoses, Prosthetic Devices, External Breast Prostheses, Therapeutic Shoes and Inserts, and their Accessories and Supplies; Custom-Made Somatic, Ocular and Facial Prostheses). You can find the complete list of deemed accreditation organizations at www.cms.gov/MedicareProviderSupEnroll/Downloads/DeemedAccreditationOrganizationsCMB.pdf
Q: Does Medicare still cover L-5781 and L-5782? I am not sure if L-5782 has been deleted since it is a heavy-duty code. I have a patient who is over the weight limit for the standard Harmony vacuum pump.
A: L-5781 (addition to lower-limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system) and L-5782 (addition to lower-limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty) are still valid codes. The average allowable for L-5781 is $3,666.12, and for L-5782 it is $3,864.92.
Q: Medicare informed me that my surety bond has expired, and I have 60 days from the date printed on the letter to obtain another one or my Medicare number will be revoked. According to Medicare, the National Supplier Clearinghouse (NSC) informed my agent of this, but unfortunately he is no longer in business. Are there any surety bond companies that Medicare recommends? I am afraid to pick one at random because of my time situation.
A: A list of surety companies from which a bond can be secured is found at the Department of the Treasury's "List of Certified [Surety Bond] Companies." You can review the complete list of certified companies at www.fms.treas.gov/c570/c570_a-z.html
Q: I am a new provider and am not that familiar with Medicare billing requirements. We have recently received a number of denials for addition codes that we billed with knee orthoses. The denial reason is "the addition code is not separately payable." Is there a list that tells me what addition codes I can bill with what base codes? I have tried to find this information and am unable to do so.
A: Medicare published a billing reminder for knee orthoses addition codes on March 18, 2011, due to recent reviews performed by the Recovery Audit Contractors (RACs). They identified errors in the billing of additions to knee orthoses. A list of all prefabricated and custom-fabricated knee orthoses along with addition codes that are payable can be found at www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_current/031811_KO.pdf
Lisa Lake-Salmon is the 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