Billing and Collections Q&#038;A

Whether you are new to O&P billing or have years of experience, denials can be frustrating to handle and difficult to appeal. Count on "Got FAQs?" to provide you with the information you need to save time and frustration. This month's column addresses your questions about stamped prescription signatures and billing criteria for L-1846 and L-1844. Q: We work with a physician who will only sign prescriptions with a stamp of the physician's name and credentials. I have told the physician's nurse I could not accept this for my files, and she insists that I can. In order to have the physician sign the prescription, the nurse is requiring that I produce documentation showing that a stamped signature is not considered acceptable for official records. Do you know where I can find this information? A: For medical review purposes, the Centers for Medicare & Medicaid Services (CMS) requires that services ordered by a physician be authenticated by a handwritten or electronic signature. With few exceptions, stamped signatures are not acceptable as described in Chapter/Section 3.3.2.4 of the Medicare Program Integrity Manual . Change Request (CR) 8219 adds another exception to that manual. Under the added exception, CMS will permit the use of a rubber stamp for signature in accordance with the Rehabilitation Act of 1973 in the case of a provider with a physical disability who can provide proof to a CMS contractor of his or her inability to sign his or her signature due to the disability. To read CR 8219, visit www.oandp.com/link/222 Q: I am located in Alabama, and the practitioner I work for asked me to verify the documentation and coverage requirements for providing patients who have Medicare coverage with L-1846 (knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated) and L-1844 (knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated). A: L-1846 and L-1844, as well as L-1834 (knee orthosis, without knee joint, rigid, custom-fabricated), L-1840 (knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated), and L-1860 (knee orthosis, modification of supracondylar prosthetic socket, custom-fabricated (SK)) are covered when there is a documented physical characteristic that requires the use of a custom-fabricated orthosis instead of a prefabricated orthosis. For a custom-fabricated orthosis, there must be detailed documentation in the treating physician's records to support the medical necessity of a custom-fabricated rather than a prefabricated orthosis. Situations that meet the criteria for a custom-fabricated orthosis include, but are not limited to, deformity of the leg or knee, size of thigh and calf, or minimal muscle mass upon which to suspend an orthosis. Although these are examples of potential situations where a custom-fabricated orthosis may be appropriate, suppliers must consider prefabricated alternatives such as pediatric knee orthoses in beneficiaries with small limbs or straps with additional length for large limbs. If a custom-fabricated orthosis is provided but the medical record does not document why that item is medically necessary instead of a prefabricated brace, the custom-fabricated orthosis will be denied as not reasonable and necessary. This information will be validated by the functional evaluation in the orthotist's or prosthetist's records. L-1846 and L-1844 are considered medically necessary if the beneficiary has had a recent injury to or a surgical procedure on the knee(s) and has one of the following diagnoses: 340, 342.90, 342.91, 342.92, 343.9, 344.1, 355.0, 355.2, 714.0-714.4, 715.16, 715.26, 715.36, 715.96, 717.0-717.5, 717.7, 717.81-717.90, 727.65, 733.15, 733.16, 733.49, 733.93, 755.64, 821.20-821.39, 822.0-822.1, 823.00-823.42, 836.0-836.69, 844.0-844.2, 844.8, 996.40-996.49, 996.66, 996.77, or V43.65. For complete coverage information, visit www.oandp.com/link/223 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 lisa@opedge.com or visit www.acc-q-data.com

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