Got FAQs?

Denials are difficult to identify and time-consuming to appeal. Count on "Got FAQs?" to help you sort through the complexities associated with O&P billing. This month's column addresses your questions about reinstated L-Codes, compliance requirements, the KX modifier, and providing prostheses to patients in comprehensive outpatient rehabilitation facilities. Q: I read that the Centers for Medicare & Medicaid Services (CMS) is no longer covering codes L-3660, L-3670, and L-3675. We have received a few prescriptions for a shoulder orthosis, and I am not sure how I should handle these claims. This particular physician sends me numerous referrals, and I do not want to turn his patients away. Any suggestions would be helpful. A: Would it surprise you to learn that CMS retracted this information on December 20, 2010, and decided not to terminate coverage on December 31, 2010, for L-3660, L-3670, and L-3675? Visit www.cignagovernmentservices.com/jc/pubs/news/2010/1210/cope13481.html . For more information, CMS maintains a Healthcare Common Procedure Coding System (HCPCS) corrections document, which is located on the HCPCS web page at www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp Q: As a relatively new provider of O&P services, I sometimes find it very confusing to keep up with all of Medicare's compliance rules and what to keep in my files. I am a one-man shop and am currently wearing many hats (practitioner, billing clerk, bookkeeper, etc.). I want to ensure that all of my patients' records are complete and in compliance. Do you have any information that would help me better understand compliance requirements? A: For a better understanding of compliance requirements, I recommend that you read the Office of Inspector General (OIG) Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Industry at http://oig.hhs.gov/authorities/docs/frdme.pdf . Noridian Administrative Services publishes documentation checklists that will help to ensure you have all the essential documentation to support the services you provide and bill for. To view the checklists, visit www.noridianmedicare.com/dme/coverage/checklists.html . There, you should find a checklist for, among others, Ankle-Foot/Knee-Ankle-Foot Orthosis, Lower-Limb Prostheses, Spinal Orthoses, and Therapeutic Shoes. Q: We have recently received quite a few denials involving the KX modifier. Either we used the modifier when we should not have or did not use it when we should have. Apparently, there are a number of ways the KX modifier applies. Do you have information about when to use this modifier-and maybe even a cheat sheet? A: To help providers better understand under what circumstances to use the KX modifier, CMS has published a KX Modifier Table. To view this publication, visit www.cignagovernmentservices.com/jc/pubs/news/2010/0510/cope12183.html Q: I have been contacted by a comprehensive outpatient rehabilitation facility (CORF) to provide a prosthesis for one of its patients. I am not sure if I can bill Medicare for this or not. Is there documentation I can review to understand how to bill for this prosthesis and under what circumstance it would be covered? What place of service (POS) should I use? I have many questions regarding this type of billing and would like to read something about it before I commit myself to a relationship with this CORF. A: When billing Medicare for services provided in a CORF, you should use POS 64. In box 32 of a 1500 form (I am not sure what software you use), you should list the name and address of the CORF where the services were furnished. For additional information, review chapter 12 of the Medicare Benefit Policy Manual, which can be found at www.cms.gov/Manuals/IOM/list.asp . You may also download a Medicare Learning Network (MLN) publication that provides, among other things, CORF place of treatment requirements and payment information. For more information, visit www.cms.gov/MLNProducts/downloads/... [PDF] 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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Pitt Schneider Elected to ACA Board of Directors

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CAF, Knights of Columbus, and Project Medishare Launch “Return to Sport” Program in Haiti

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