Sunday, May 19, 2024

Dynamic Arm repairs-Medicare

Rick Stapleton

Good morning list-serve,

I have an invoice from Otto Bock for a Dynamic arm repair that shows 420 minutes of labor and then all the parts. The 420 minutes comes to 28 units of 15 minutes. They charge me $1$$.04/hr, so a manufacturer can charge us what ever we can bear, yet we get much less reimbursement from Medicare (and even less from other insurers.) I am told we are supposed to bill using labor and small parts, yet I will lose money on the labor side because we get paid much less than what we pay the manufacturer. Then there is the matter of the units of labor billed which is surely going to cause a denial (we have been denied 16 units before when restoring bilateral metal and leather KAFOs) although after much fighting and of course documenting everything that was done, we finally got paid the 16 units. What worries me is 28 units at a cost that far exceeds what I get reimbursed, how do I bill this out in a way that isn’t fraudulent, yet allows me to get paid for the work done? I have been told that using the 5999 or 7499 code is not the proper way to bill for these repairs, so I need advice from someone who has done this several times and got paid without losing money.

It is sad in this environment that we get paid less per hour than the people that work on my computers, fix my copier, and even the plumbers that fix my toilets, yet none of them are required to have medical liability, document every breath, mandatory professional education to keep up our credentials, and hold the health of peoples lives in their hands.

Sorry for the rant, thanks for all the replies in advance, this is an incredible resource, thanks Paul!


Rick Stapleton, CPO

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