<img style="float: right; margin-left: 3px;" src="https://opedge.com/Content/OldArticles/images/2009-02_09/faq.jpg" alt="Lisa Lake-Salmon" /> <b><i>Denials are difficult to identify and time consuming to appeal. Count on "Got FAQs?" to help keep your O&P billing running smoothly. This month's column tackles your questions about licensure, denials on lumbar-orthosis claims, and the revised time period for filing fee-for-service claims.</i></b> <span style="font-size: 14pt;"><b style="color: #ce1429;">Q:</b> </span>I want to open a new O&P practice in the state of Georgia. Do you know where I can find licensure information for Georgia and other states? <span style="font-size: 14pt;"><b>A:</b></span> Since licensure requirements differ from state to state, you should check with your state and local governments for the licenses required for an O&P practice. You may be required to have sales permits and state sales tax or professional licenses for various fields. The National Supplier Clearinghouse (NSC) publishes the licensure requirements for each state. You can find this information at <a href="https://opedge.dev/3360" target="_blank" rel="noopener noreferrer">www.palmettogba.com/palmetto/providers.nsf/docscat/providers~national%20supplier%20clearinghouse~resources~ licensure%20information~licensure%20information?open&navmenu=</a> <span style="font-size: 14pt;"><b style="color: #ce1429;">Q:</b></span> I am new to medical billing, and I am getting the hang of most things except Medicare. I have several claims for L-0627 that keep coming back to me as denied. I added the CG modifier, and I am still receiving denials. I do not understand what I am doing wrong. <span style="font-size: 14pt;"><b>A:</b> </span>You did not state which denial code you are receiving from Medicare or the diagnosis code with which you are billing, but according to Medicare guidelines, an L-0627 (Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment) is covered when it is prescribed for one of the following reasons: to reduce pain by restricting mobility of the trunk; to facilitate healing following an injury to the spine or related soft tissues; to facilitate healing following a surgical procedure on the spine or related soft tissue; or to otherwise support weak spinal muscles and/or a deformed spine. The CG modifier must be added to codes L-0450, L-0454, L-0625, or L-0628 only if it is made primarily of non-elastic material. To review the policy, visit <a href="https://opedge.dev/3361" target="_blank" rel="noopener noreferrer">www.cms.gov/mcd/viewlcd.asp?lcd_id=11448&lcd_version=32&show=all</a> <span style="font-size: 14pt;"><b style="color: #ce1429;">Q:</b> </span>Every year, we review our files to ensure that we submitted all of our claims. We usually find a handful of claims that are more than a year old, and we submit them to Medicare for reimbursement. I recently heard that the time limit for filing claims has changed. Do you know how long we have to submit a claim to Medicare? Did the filing limits change? <span style="font-size: 14pt;"><b>A:</b> </span>On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service claims. Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. To review the complete policy change, visit <a href="https://opedge.dev/3362" target="_blank" rel="noopener noreferrer">www.cignagovernmentservices.com/jc/pubs/news/2010/0410/cope11966.html</a> <i>Lisa Lake-Salmon is the executive vice president of Acc-Q-Data, which provides billing, collections, and practice management software. She has been serving the O&P profession for more than a decade. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. While every attempt has been made to ensure accuracy,</i> The O&P EDGE <i>is not responsible for errors. For more information, contact <script language="javascript">linkEmail('lisa','opedge.com');</script> or visit <a href="https://opedge.dev/3210" target="_blank" rel="noopener noreferrer">www.acc-q-data.com</a></i>
