<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2007-02_09/Lake-Salmon,-Lisa-(sm).jpg" hspace="4" vspace="4" /> <b><i>Claim denials can become the bane of your existence if you're not current on Medicare rules and regulations. Who has time to keep up with all of that, anyway? Count on "Got FAQs" to keep you informed and help you and your staff better understand billing procedures and reimbursement strategies.</i></b> <b><i>Q:</i> I received a denial from Blue Cross Blue Shield (BCBS) of Michigan stating my claim cannot be processed as billed. I submitted L-1906 RT LT. I do not understand why this would deny since I receive payment from Medicare on this all the time. Are you familiar with this insurance company?</b> <b>A:</b> Unlike DMERC, when billing BCBS of Michigan you must submit your claim as two separate line items. If you bill L-1906 RT as one line item, then bill L-1906 LT on the next claim line. Given the information you provided, this should get your claim paid. <b><i>Q:</i> Our office received a prescription for a TLSO (L-0462). We asked the patient if he previously received a back brace, and the patient said no. The patient was fitted, and we filed the claim to Medicare. We received a CO-57 denial, same or similar equipment. Can we appeal this?</b> <b>A:</b> If you can obtain additional documentation showing the old brace is no longer adequate due to wear and tear, because the patient had a weight gain or loss and the brace no longer fits, because the brace was damaged or stolen, etc., you can appeal your denial with this additional documentation, and Medicare will consider paying for another brace if it feels the information submitted deems it medically necessary. When receiving a denial code of CO-57 from DMERC, you must file your appeal within 120 days of the denial date on the EOB. <b><i>Q:</i> I am trying to submit a claim electronically to Medicare for L-3914. I keep receiving front-end rejections and cannot seem to get this claim through to Medicare.</b> <b>A:</b> Effective January 1, 2007, L-3914 is no longer a valid code. It has been replaced by L-3908. Resubmit your claim with L-3908 and the appropriate RT or LT modifier, and this should resolve your issue. <i>We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, contact </i><a href="mailto:lisa@opedge.com"><i>lisa@opedge.com</i></a> <i>Lisa Lake-Salmon is the executive vice-president of Accu-Q-Data, which has provided billing, collections, and practice management software serving the O&P industry nationwide for more than a decade.</i>
<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2007-02_09/Lake-Salmon,-Lisa-(sm).jpg" hspace="4" vspace="4" /> <b><i>Claim denials can become the bane of your existence if you're not current on Medicare rules and regulations. Who has time to keep up with all of that, anyway? Count on "Got FAQs" to keep you informed and help you and your staff better understand billing procedures and reimbursement strategies.</i></b> <b><i>Q:</i> I received a denial from Blue Cross Blue Shield (BCBS) of Michigan stating my claim cannot be processed as billed. I submitted L-1906 RT LT. I do not understand why this would deny since I receive payment from Medicare on this all the time. Are you familiar with this insurance company?</b> <b>A:</b> Unlike DMERC, when billing BCBS of Michigan you must submit your claim as two separate line items. If you bill L-1906 RT as one line item, then bill L-1906 LT on the next claim line. Given the information you provided, this should get your claim paid. <b><i>Q:</i> Our office received a prescription for a TLSO (L-0462). We asked the patient if he previously received a back brace, and the patient said no. The patient was fitted, and we filed the claim to Medicare. We received a CO-57 denial, same or similar equipment. Can we appeal this?</b> <b>A:</b> If you can obtain additional documentation showing the old brace is no longer adequate due to wear and tear, because the patient had a weight gain or loss and the brace no longer fits, because the brace was damaged or stolen, etc., you can appeal your denial with this additional documentation, and Medicare will consider paying for another brace if it feels the information submitted deems it medically necessary. When receiving a denial code of CO-57 from DMERC, you must file your appeal within 120 days of the denial date on the EOB. <b><i>Q:</i> I am trying to submit a claim electronically to Medicare for L-3914. I keep receiving front-end rejections and cannot seem to get this claim through to Medicare.</b> <b>A:</b> Effective January 1, 2007, L-3914 is no longer a valid code. It has been replaced by L-3908. Resubmit your claim with L-3908 and the appropriate RT or LT modifier, and this should resolve your issue. <i>We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, contact </i><a href="mailto:lisa@opedge.com"><i>lisa@opedge.com</i></a> <i>Lisa Lake-Salmon is the executive vice-president of Accu-Q-Data, which has provided billing, collections, and practice management software serving the O&P industry nationwide for more than a decade.</i>