<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2005-05_07/LakeSalmonLisa.jpg" hspace="4" vspace="4" /> 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. <b><i>Q: I recently received a denial for a tibial length sock, yet I was paid for the AFO. Why would Medicare not pay for the sock?</i></b> <b>A:</b> L-2840 (addition to lower extremity orthosis, tibial length sock, fracture or equal), and L-2850 (addition to lower extremity orthosis, femoral length sock, fracture or equal) used in conjunction with orthoses are noncovered. Therefore, there would be no reimbursement for these codes. <b><i>Q: I billed Medicare for an L-8035 and received payment for an L-8030. Why would Medicare downcode this to a less expensive prosthesis?</i></b> <b>A:</b> According to Region C, the additional features of a custom-fabricated prosthesis (L-8035), compared to a prefabricated silicone breast prosthesis, are not medically necessary. Therefore, if an L-8035 is provided to a patient who has had a mastectomy, payment will be based on the allowance for the least costly appropriate alternative, L-8030. <b><i>Q: Is it true that a provider will need to have a specialty code in the future in order to bill Medicare? How do I know what my code is and if I have one?</i></b> <b>A:</b> Effective July 1, 2005, Medicare will only reimburse for prosthetics and certain custom-fabricated orthotics when furnished by a qualified practitioner or a qualified supplier. If you want to bill Medicare for P&O, you should contact the National Suppliers Clearinghouse (NSC) at 866.238.9652 to verify that it has your correct specialty code on file. If you need to update your file with the correct specialty code, you must submit a change of information to the NSC on a CMS 855S form. <i>We invite readers to ask any questions you may have regarding billing, collections, or any other information. To send your questions or for more information, contact: <a href="mailto:lisa@westernmediallc.com">lisa@westernmediallc.com</a></i> <i>Acc-Q-Data provides billing, collections, and practice management software, serving the O&P industry nationwide for over a decade. For more information contact <a href="mailto:lsalmon@acc-q-data.com">lsalmon@acc-q-data.com</a></i> <i>Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc.</i>
<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2005-05_07/LakeSalmonLisa.jpg" hspace="4" vspace="4" /> 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. <b><i>Q: I recently received a denial for a tibial length sock, yet I was paid for the AFO. Why would Medicare not pay for the sock?</i></b> <b>A:</b> L-2840 (addition to lower extremity orthosis, tibial length sock, fracture or equal), and L-2850 (addition to lower extremity orthosis, femoral length sock, fracture or equal) used in conjunction with orthoses are noncovered. Therefore, there would be no reimbursement for these codes. <b><i>Q: I billed Medicare for an L-8035 and received payment for an L-8030. Why would Medicare downcode this to a less expensive prosthesis?</i></b> <b>A:</b> According to Region C, the additional features of a custom-fabricated prosthesis (L-8035), compared to a prefabricated silicone breast prosthesis, are not medically necessary. Therefore, if an L-8035 is provided to a patient who has had a mastectomy, payment will be based on the allowance for the least costly appropriate alternative, L-8030. <b><i>Q: Is it true that a provider will need to have a specialty code in the future in order to bill Medicare? How do I know what my code is and if I have one?</i></b> <b>A:</b> Effective July 1, 2005, Medicare will only reimburse for prosthetics and certain custom-fabricated orthotics when furnished by a qualified practitioner or a qualified supplier. If you want to bill Medicare for P&O, you should contact the National Suppliers Clearinghouse (NSC) at 866.238.9652 to verify that it has your correct specialty code on file. If you need to update your file with the correct specialty code, you must submit a change of information to the NSC on a CMS 855S form. <i>We invite readers to ask any questions you may have regarding billing, collections, or any other information. To send your questions or for more information, contact: <a href="mailto:lisa@westernmediallc.com">lisa@westernmediallc.com</a></i> <i>Acc-Q-Data provides billing, collections, and practice management software, serving the O&P industry nationwide for over a decade. For more information contact <a href="mailto:lsalmon@acc-q-data.com">lsalmon@acc-q-data.com</a></i> <i>Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc.</i>