Billing and Collections Q&A - April 2020

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By Lisa Lake

Billing for O&P devices and care is complicated. When you have questions, count on Got FAQs? to help keep your claims on track. This month's column answers your questions about prior authorizations and making corrections to claims. 

Q:  I work for an O&P provider in Alabama, and am always trying to find ways to work with Medicare more efficiently. We have a new member of our staff who has made several coding errors on our Medicare claims, which leads to a denial, and requires that we correct and resubmit the claim to Medicare for a reopening. It seems to be a long process and our cash flow is being affected. Can you offer information or tips to help us with the process?

A:  Medicare published a news release on December 23, 2019, announcing that claims can be corrected on the myCGS portal. The following items on a claim can be corrected via the Claim Correction process in myCGS: Place of Service; HCPCS codes (except for miscellaneous codes beginning with WW, and codes that include modifiers KX, GA, GY, and/or GZ); Modifiers (except for KX, GA, GY, and GZ modifiers); Date of Service (From and To Dates); Number of Services; Submitted Amount; and Diagnosis Codes. For instructions about how to navigate the portal, visit https://bit.ly/2TJyYPj. 

Q:  I work for an O&P provider in Texas. I do all the benefits verifications and prior authorizations, and find it extremely time consuming to submit prior authorizations to BCBS of Texas. They often say they haven't received the information I sent. A representative told me they will soon be changing how prior authorizations are processed. Can you help me deal with the prior authorizations more efficiently?

My boss also requested I research whether Medicare has announced anything about prior authorizations for prostheses, but I am unable to find this information. Can you point me in the right direction? 

A:  EffectiveJanuary 30, providers in Texas can use www.­bcbstx.com/provider/news/2019_12_24.html to submit prior authorizations and referrals. First, register and log in on the Availity website at www.availity.com. Then go to the Patient Registration menu option, choose Authorizations & Referrals, then Authorizations. Select Payer BCBSTX, and choose your organization. From there, select Inpatient Authorization or Outpatient Authorization, and review and submit your authorization. If you need assistance, call Availity Client Services at 800-282-4548. 

Medicare issued a News Bulletin on February 27 about prosthetic codes that will need prior authorizations. The codes are as follows: L-5856 (Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type); L-5857 (Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type); L-5858 (Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type); L-5973 (Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source); L-5980 (All lower extremity prostheses, flex foot system); and L-5987 (All lower extremity prosthesis, shank foot system with vertical loading pylon). The new prior authorization process will be implemented in two phases. Phase one will begin May 11 in one state from each DME MAC jurisdiction (California, Michigan, Pennsylvania, and Texas). Phase two will begin October 8 and expands prior authorization of these codes to all remaining states and territories. The Required Prior Authorization List can be found at https://go.cms.gov/2TEPoZi. 

Lisa Lake is an independent medical consultant with over 25 years of experience in the O&P industry, increasing providers' revenue by product recommendation, product and billing knowledge, and contract access assistance. She is a nationally recognized speaker on billing reimbursement and government compliancy. While every attempt has been made to ensure accuracy, The O&P EDGEis not responsible for errors. Lake can be contacted at llakeusa@gmail.com.