<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2005-12_04/gf--.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>Q: If there is a Medicare allowable, can a provider charge for an item when the manufacturer does not charge for it separately?</b> <b>A:</b> The provider cannot bill Medicare when the manufacturer's invoice does not reflect a separate charge for the item in question. <b>Q: A patient came into my office with a prescription for a CAM walker. The patient had already received an AFO brace in the beginning of the year. Will Medicare now pay for the CAM walker, and if so how should I bill? Please help, as I can not afford to keep giving products away free</b>. <b>A:</b> Medicare will not cover a CAM walker, since the patient already received an AFO brace in the same calendar year. If you give the patient a CAM walker, you must have the patient sign an ABN form (Advance Beneficiary Notice), informing the patient that Medicare will not cover this item and the cost would be his or her responsibility. You need to bill using the GA modifier, letting Medicare know that you have a signed ABN on file. This then will allow you to bill the patient once Medicare denies. <b>Q: I received an overpayment request that I disagree with. If I appeal the request, do I still have to refund the money to Medicare?</b> <b>A:</b> Yes. A request for an appeal will not alter the overpayment request. If an appeal results in a partially or fully favorable decision, an appropriate refund will be made to the provider. Any overpayment due to Medicare should be made within 30 days after the first demand letter. <i>We invite readers to ask questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact: </i><a href="mailto:lisa@weternmediallc.com"><i>lisa@weternmediallc.com</i></a> <i>Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for over a decade.</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/2005-12_04/gf--.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>Q: If there is a Medicare allowable, can a provider charge for an item when the manufacturer does not charge for it separately?</b> <b>A:</b> The provider cannot bill Medicare when the manufacturer's invoice does not reflect a separate charge for the item in question. <b>Q: A patient came into my office with a prescription for a CAM walker. The patient had already received an AFO brace in the beginning of the year. Will Medicare now pay for the CAM walker, and if so how should I bill? Please help, as I can not afford to keep giving products away free</b>. <b>A:</b> Medicare will not cover a CAM walker, since the patient already received an AFO brace in the same calendar year. If you give the patient a CAM walker, you must have the patient sign an ABN form (Advance Beneficiary Notice), informing the patient that Medicare will not cover this item and the cost would be his or her responsibility. You need to bill using the GA modifier, letting Medicare know that you have a signed ABN on file. This then will allow you to bill the patient once Medicare denies. <b>Q: I received an overpayment request that I disagree with. If I appeal the request, do I still have to refund the money to Medicare?</b> <b>A:</b> Yes. A request for an appeal will not alter the overpayment request. If an appeal results in a partially or fully favorable decision, an appropriate refund will be made to the provider. Any overpayment due to Medicare should be made within 30 days after the first demand letter. <i>We invite readers to ask questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact: </i><a href="mailto:lisa@weternmediallc.com"><i>lisa@weternmediallc.com</i></a> <i>Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for over a decade.</i> <i>Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.</i>