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Running an O&P practice and keeping billing on track is complex and time-consuming. When you have a billing-related question, "Got FAQs?" has the answer. This month's column addresses your questions about Medicare requirements for therapeutic shoes, billing for post-mastectomy products, and surety bond requirements. Q: A colleague who recently took a therapeutic-shoe course informed me that, according to the course, some of the requirements for Medicare have changed, and I will need additional paperwork beginning in July 2010. Where can I find this information on the Medicare Region C website? A: The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards published in October 2008 covers specific requirements for orthoses, prostheses, and therapeutic shoes. For claims with dates of service on or after July 1, 2010, the following documentation requirements must be met: The in-person evaluation must include at least an examination of the patient's feet with a description of the abnormalities that will need to be accommodated by the shoes/inserts/modifications. For all shoes, documentation must include taking foot measurements. For custom-molded shoes (A-5501) and inserts (A-5513), documentation must also include taking impressions, making casts, or obtaining CAD/CAM images of the patient's feet that will be used to create positive models of the feet. You may review the complete publication titled Therapeutic Shoes-In-Person Fitting and Delivery at www.cignagovernmentservices.com/jc/pubs/news/2010/0510/cope12172B.html Q: I own a DME mastectomy-only business. I am having many problems getting the new fee schedule for Medicare and Medicaid. I bill both for my customers and do not have updates. I know there are new L-Codes that I need more information about. Where can I find this information? Also, can we bill nipples for mastectomy patients? A: You did not mention what state you are located in. For the Region C fee schedule, go to www.cignagovernmentservices.com/medicare_dynamic/fees/jc/search.asp . If you would like to see a complete list of all new or deleted Healthcare Common Procedure Coding System (HCPCS) codes for 2010, go to www.cignagovernmentservices.com/jc/pubs/news/2009/1209/cope11266.html . You can bill Medicare for L-8032 (nipple prosthesis, reusable, any type, each). The useful life expectancy for a nipple prosthesis is three months. The average allowable amount for L-8032 is $35.73 each. Q: I am a new provider in North Carolina, and I am looking for information on the Medicare surety bond requirements. I also need to find a list of the supplier standards so I can display the complete list for my patients to view. Any help on where I can find this information would be greatly appreciated. A: The Centers for Medicare & Medicaid Services (CMS) issued change request 6854 on March 26, 2010, which relates to information regarding surety bond requirements and exemptions. To review the complete policy, go to www.cms.gov/transmittals/downloads/R332PI.pdf . Medicare regulations have defined standards that a supplier must meet to receive and maintain a supplier number. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c) and can be found on the National Supplier Clearinghouse (NSC) website at www.palmettogba.com/nsc . You must disclose these standards to all patients who are Medicare beneficiaries. Lisa Lake-Salmon is the 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, The O&P EDGE is not responsible for errors. For more information, contact linkEmail('lisa','opedge.com'); or visit www.acc-q-data.com

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