Billing & Collections Q&A

Whether you are just starting an O&P practice and need help or you've been running a practice for years and have a billing question, 'Got FAQs?' is there with the answers you need to help keep your business running smoothly. This month's column tackles your questions about expert witnesses, establishing a new orthotic business, policy changes for elastic garments, and more. Q: I am a practitioner in the state of Alabama. I am in desperate need of an expert witness in the field of prosthetics who can appear in court to assist me in a case I have with an insurance company for a $90,000 bilateral prosthesis I have provided. Any help would be greatly appreciated. 0 To find an expert witness in the field of prosthetics, visit www.jurispro.com/category/orthotics-and-prosthetics-s-439 . You will find a listing of professionals who provide expert-witness testimony on prostheses, braces, and orthotic devices. Keep us informed on your case. I wish you luck and hope you win one for the good guys! Q: I am interested in establishing a new orthotics business in the state of New York. What are the requirements to set up a new orthotics/DME company to operate in New York? A: Best of luck in your new venture. To find information regarding Medicare's licensing requirements, visit palmettogba.com/palmetto/statelicensure.nsf . For additional information on the state's requirements, you may also review the regulations of the Commissioner of New York at www.op.nysed.gov/part76.htm Q: I am the office manager for a practice in Columbia, South Carolina. According to the Centers for Medicare & Medicaid Services (CMS) manual, the diagnosis codes to support L-1845 for billing are all neurological; however, this brace is made for structural problems of the knee (i.e., ACL injuries, etc.). This does not make sense-L-1830, L-1832, and several other codes are supported by diagnoses of structural injuries, as the L-1845 should be. How do we bill this code accurately and get paid? A: A knee orthosis with an adjustable flexion and extension joint that provides both medial-lateral and rotation control (L-1843, L-1845) is covered for a patient who is ambulatory and has knee instability due to a condition specified in one of the following diagnoses: multiple sclerosis (340); hemiplegia, unspecified (342.90); infantile cerebral palsy, unspecified (343.9); paraplegia of both lower limbs (344.1); mononeuritis of lower limb, unspecified (355.0, 355.2); and any diagnosis listed for L-1830/L-1832 . For a complete list of diagnosis codes, visit www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=22664&lcd_version=9&show=all When billing L-1845, you must use the KX, RT, and/or LT modifiers. Addition codes that are eligible for separate payment with the L-1845 are L-2385, L-2395, L-2397, and L-2795. Q: I know there have been policy changes regarding the coverage of elastic garments. Where I can find information regarding this on Medicare's website? I am a Region C provider. A: Effective April 1, 2009, Medicare has changed its policy regarding the coverage of elastic garments. To view the publication regarding the new policy in its entirety, visit www.cignagovernmentservices.com/jc/pubs/news/2009/0109/cope9205.html 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 linkEmail('lisa','opedge.com'); or visit www.acc-q-data.com

Billing & Collections Q&A

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BOC President Resigns; Nationwide Search Underway

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