<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2006-01_08/gf--[1].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: Recently and in the past I have billed code K-0628 and K-0629, which are diabetic inserts. I have been informed by Medicare to bill these codes two different ways, and at this time I am still unsuccessful in getting them paid. Please help me get these codes paid.</b> <b>A:</b> Codes K-0628 and K-0629 are diabetic inserts that go along with diabetic shoes. In order for these codes to be covered, the patient must be a diabetic, therefore using a diabetic diagnosis code, e.g. 250.00. You also must use the modifiers LT / RT specifying which foot, if not both, and KX modifier, which informs Medicare that the shoes are covered due to the patient being a diabetic. <b>Q: I recently have submitted claims to Medicare Region C for patients that reside in Region B; my office is located in Region C. We have received denials, and Medicare informed us that we needed to submit paper claims to Region B. I was under the notion that if we submitted the claims to Region C, they would be forwarded to the correct Region if necessary. Please tell me what I am doing wrong.</b> <b>A:</b> In order to submit claims to a different Region, other than the Region your office is located in, you must have the correct information on the claim, e.g. the patient's address and state must fall under the Region you are billing to. You are able to submit directly to the Region where the patient resides electronically or via hardcopy. Medicare will not forward claims to a different Region from the one you submitted to originally. <b>Q: We currently have encountered a situation with Medicare Region C denying some of our non-assigned claims that were billed with a GA modifier and submitted with a signed ABN form. Medicare stated that we had to refund the payment that the patient paid for claims that denied with a CO denial code, even though we had an ABN on file. Our question is: Can Medicare ask us to refund the patient's money even though we billed with the GA modifier and submitted an ABN?</b> <b>A:</b> Yes, Medicare can ask you to refund the money. You cannot bill a non-assigned claim with a GA modifier, even with an ABN (Advanced Beneficiary Notice) on file. You must use a GY modifier when submitting a non-assigned claim with NO ABN on file. The only way you can utilize the ABN modifier (GA) is when billing a claim as accepting assignment. <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@opedge.com"><i>lisa@opedge.com</i></a> <i>Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade.</i>
