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Denials are difficult to identify and time consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, and increased billing errors, running an O&P shop gets more complicated each year. Q: I have searched everywhere for a diabetic shoe form that I need to have filled out by the physician. Since DMERC continuously changes its website, I cannot find this anywhere. Please help while there is still hair left on my head. A: The form you need is called " Statement of Certifying Physician for Therapeutic Shoes " Q: I recently billed Medicare for services that took place in the office using place-of-service code 11. My claims were denied with a denial code of CO-16. When I contacted Medicare, they informed me it was due to an incorrect place-of-service code. What did I do wrong and how can I correct this with Medicare? I was also informed that I now need to put a specific place-of-service code for services provided at a prison. Do you know the code I would use? A: Anytime you bill Medicare for services that the patient can take home, the item and/or benefits from the services at home must be billed with a place-of-service code 12. The place-of-service code 11 is used more for procedures that are done in the office and/or hospital services. Since your claim was denied for CO-16 (lacks information for adjudication), you will need to submit a new claim to Medicare with the corrected information. Effective January 2008, if you provide services to a patient in a prison or correctional facility, the place-of-service code will be 09. Q: I have received multiple denials CO-50 (not medically necessary) when billing L-5980 along with L-5540. I received payment on L-5540, but they are denying the L-5980, and I cannot figure out why. A: The L-5980, Flex-Foot® system, is not meant to be used with the L-5540, below-the-knee prothesis with a SACH foot interface. The coverage is according to functional levels, which for L-5980 is level 3 and for L-5540 is level 1. Q: I am a provider in Illinois. I received a denial from Region B stating the claim was not covered by this payer or contractor. I was told that if I submit my claim to Region B, they would forward the claim to the correct DMERC region the patient is listed with. Is this not true? A: According to National Government Services (NGS), the patient DMEPOS jurisdiction is based on the beneficiary's address on file with the Social Security Administration (SSA). Providers should verify that the address they have on file for the beneficiary is the same address listed with SSA. You may also want to purchase real-time patient-eligibility software to verify all of your patient benefits. 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. 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

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