Billing and Collections Q&A

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By Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. If you have a billing question or a question about a denial, "Got FAQs?" can help you sift through the confusion and get you the answers you need. This month's column answers your questions about surety bonds for Medicare, modifiers for L-4002, and new electronic funds transfer requirements for Medicare payments.

Q: We are opening another O&P facility in a different state than where we currently operate. My new office manager and I are having a disagreement regarding whether we are required to have a surety bond for Medicare. We would like to get our Medicare provider number for the new location and want to make sure we have everything we need.

A: The Centers for Medicare & Medicaid Services (CMS) published an Accreditation & Surety Bond Exemptions chart, which illustrates durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) provider exemptions from either the accreditation or surety bond requirement in order to obtain Medicare billing privileges. CMS recommends that you review the list of surety bond FAQs on the National Supplier Clearinghouse (NSC) website for more detailed information on the exemptions to the bond. Providers are reminded that accreditation and surety bond exemptions only extend to the normal scope of services for the supplier specialty. Any products or services provided outside the normal range of services will require accreditation and/or a surety bond to obtain/maintain Medicare billing privileges. To view the Accreditation & Surety Bond Exemptions chart, visit www.oandp.com/link/174. To view the Surety Bond FAQs, visit www.oandp.com/link/175

Q: I work for a DMEPOS provider in West Virginia. We are receiving rejections for Healthcare Common Procedure Coding System (HCPCS) code L-4002 (replacement strap, any orthosis, includes all components, any length, any type). We use the LT/RT, RB and KX modifiers when needed. Is there another modifier we need to use so we can avoid denials?

A: You did not specifically state why Medicare is denying your claim. If it is denying your claim for incorrect modifiers, the following would apply when billing for L-4002. The only modifiers used should be a KX, GA, or GZ, along with RT or LT. A new physician's order is not needed for repairs. The supplier must maintain detailed records describing the need for and nature of all repairs including a detailed explanation of the justification for any component or part replaced as well as the labor time. This information can be found in the Local Coverage Determination (LCD) for knee orthoses at www.oandp.com/link/176

Q: We have been Medicare providers for more than ten years and have always received our Medicare checks in the mail. We recently had to fill out a provider enrollment form to update some of our company information, and I am now being told I must submit a voided check to Medicare so that we can receive payments via electronic funds transfer (EFT). Is this the only way providers can receive payment going forward?

A: A recent posting on one of the CMS contractor's websites, CGS Administrator, "All Medicare Provider and Supplier Payments Will Be Made via Electronic Funds Transfer" quoted Medicare policy, which states the following: : "Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means. As part of CMS revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official." To read the article, visit www.oandp. com/link/177. For more information about provider enrollment revalidation, review the Medicare Learning Network's Special Edition Article #SE1126, titled "Further Details on the Revalidation of Provider Enrollment Information."

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