The future of your practice depends on
knowledgeable billing and collection information. Understanding the
full aspect of billing guidelines and procedures will effectively
increase your reimbursement. This informative column will help
providers and their staff with a better understanding of billing
procedures and reimbursement strategies.
Q: In the April 2004 edition of The O&P
EDGE, you answered a question involving billing Medicare for
items that were delivered to the patient while he/she was in the
hospital. My question to you is: What happens in the case of a
patient being discharged and then going to a skilled nursing
facility or assisted living facility? Do the same rules
apply?
A: If a patient goes into a SNF (skilled
nursing facility), their Medicare Part A coverage is in effect for
100 days from the date of admission. After the 100 days, their
Medicare Part B takes effect, and therefore you would be able to
bill Medicare for services. If the patient goes into an ALF
(assisted living facility), they continue to have their Medicare
part B in effect, and therefore you would be able to bill Medicare
for your services without having to wait the 100 days. Therefore,
if the patient is discharged from the hospital and goes into a SNF,
you would not be paid.
Q: I’m an O&P provider and recently billed
Medicare for the services that took place in the office, using a
place of service code 11. My claims were denied with a denial code
of CO-16. When I contacted Medicare, they informed me it was due to
an incorrect place of service code. What did I do wrong, and how
can I correct this with Medicare? Does my claim now have to go into
review?
A: Anytime you bill Medicare for services in
which the patient can take the item home and/or benefits from the
services while at home, you must bill with a place of service code
12. The place of service code 11 is used more for procedures that
are done in the office and/or hospital services. You do not have to
send your claim into review because it was denied as CO-16 (Lacks
Information for Adjudication); therefore, you would only need to
submit a new claim to Medicare with the corrected information.
We invite readers to ask any questions you have regarding
billing, collections, or any other information. To send your
questions or for more information, contact: [email protected]
Acc-Q-Data provides billing, collections, and practice
management software serving the O&P industry nationwide for
over a decade.
Lisa Lake-Salmon is Executive Vice President of Acc-Q-Data Inc.
