Got FAQs?

Having trouble keeping up with the new Medicare 2007 rules and regulations? Overwhelmed by the numerous code changes? Count on "Got FAQs" to help you understand the full aspect of billing guidelines and procedures, which will effectively increase your reimbursement. Q: A colleague of mine stated that Medicare will not accept my claims in the future without an NPI (National Provider Identifier) number. Is this true? How do I apply for one, and when do I need to start using it? A: Beginning May 23, 2007, all DMEPOS suppliers must begin using an NPI number when submitting claims to the DMERCs. I urge you to apply for your NPI number as soon as possible, as time is running out. You may fill out your application online at https://nppes.cms.hhs.gov Q: I am a contract specialist for a large O&P facility, and I have a question regarding NPI numbers. I noticed in the December 2006 issue of The O&P EDGE your answer about multiple locations. Since we are required to have a Medicare number for each of our locations, are we required to have an NPI number for each location with a Medicare number? A: According to DMERC, if you are a sole proprietor of your practice, it is not necessary to obtain an NPI number for each location. If a Medicare supplier is a sole proprietor, the supplier is eligible for only one NPI number regardless of the number of locations it may have. If you are not a sole proprietor of your practice, then it is necessary to obtain an NPI number for each location. If your company is a corporation and has multiple owners, then it is necessary to obtain an NPI number for each of your locations. Q: I recently received a denial from Region B on a claim for a preparatory BK proshesis (L-5540, L-5620, L-5940, L-5910, L-5647, L-5679, L-5972, L-5986, L-8420, L-8470, L-8440). All codes were paid except L-5647, which was denied as not medically necessary. Is there anything I can do to get this code paid? I called Medicare, and the claim representative told me "no." A: In the December 2006 advisory, Medicare stated that the coding guidelines for L-5647 and L-5652 are being revised as follows: "A suction valve (L-5647, L-5652) is rarely needed when a suspension locking mechanism is being used. If both are provided, there should be documentation in the supplier's records that describes the medical necessity of each for the specific patient." I suggest you submit your claim for review with documentation supporting the need for L-5679 (gel liners) in conjunction with L-5647 (suction socket), as it is now considered acceptable to use a suction socket as a means of suspension of the prosthesis and a non-locking gel liner as an interface between the limb and the prosthetic socket. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, contact lisa@opedge.com Lisa Lake-Salmon is the executive vice president of Acc-Q-Data, which provides billing, collections, and practice management software and has been serving the O&P industry for more than a decade.

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