ORIGINAL POST
Hi List members,
Has anyone sorted through the new policy for KO reimbursements? There
are now 101 new ways to get denials and we’re starting to get them.
Will whoever helped Medicare come up with this policy (if you understand
it) please create a flow chart so we don’t have to spend 20 minutes for
each code we bill? Maybe someone who likes brain teasers or puzzles
would like this challenge..or someone who likes the challenge of doing
their own taxes!
To see this policy for Region D , check out;
http://www.cignamedicare.com/dmerc/LMRP_LCD/draft/KneeOrth_draft.html
Is this set in stone? Randy McFarland, CPO Fullerton, CA
RESPONSES
You need to go to an AOPA coding course. They have worked out matrices
for
coding that guide you thru KOs and LSOs. As for the medical policy it is
still at the draft stage and could change,
for better or for worse.
It reminds me of the Capitol One commercials! 1001 ways to say NO!!! I
wonder how many senators or congress members are on Medicare.
What you are seeing in your region is happening in
region c from last two years, it will be very
frustrating experience for sure. Bottom line is
document everything including bio-mechanical concept
of orthosis, describe function of each component on
orthosis e.g. why patient need double upright?,etc.
If they will ask for information as they did in region
c, you will be responsible to obtain physician notes,
if physician fails to appropriately write his own
note, you may be punished for it by denial of payment.
There is no telling what they will want you to
submit, they have asked us our notes, physician notes,
invoice from manufacturer etc. Obtaining a detail RX
from physician will help you too. Hope this helps.
