This month’s column covers prior authorization and sequestration, and requirements about face-to-face exams, written orders prior to delivery, same or similar devices, and custom-made items ordered but not furnished.
Q: At the end of July, I received a denial from Medicare because I did not obtain prior authorization for knee brace codes L-1833 and L-1851. When did this start? How do I go about obtaining it? I also noticed our July Medicare payments seem to be less. Did they make an adjustment to the fee schedule? Now we are told we need to ensure we have specific documentation when we are having a face-to-face visit with some patients and on some we do not. Are there any steps we can take to avoid a denial for insufficient paperwork and determine whether the patient ever received this device before? All these new processes are a bit much to continually keep up with. We are a small facility in rural Georgia. Any advice or information you can provide would be appreciated.