Got FAQs?

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By Lisa Lake-Salmon

The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.

Q:I am a relatively new prosthetist and was wondering if Medicare will cover repairs or adjustments made to a patient's prosthesis?

A: Any repairs or adjustments made to the prosthesis within the first 90 days of fitting are not paid for separately; Medicare considers that as included in the reimbursement for the prosthesis. After the initial 90 days, you would then use either L-7510 (repair) and/or L-7520 (labor per 15 minutes).

You will need to explain to Medicare in your additional documentation exactly what the repairs were for. Remember to always use the proper modifiers: RP (repair); RT or LT (specifies which leg); K1, K2, K3, or K4 (what functional level).

Q:Can you help me settle a dispute between myself and a colleague? How long is a provider required to keep proof-of-delivery documentation on file?

A: According to DMERC, suppliers are required to maintain proof of delivery documentation in their files for seven years.

Q:I billed a breast prosthesis to Medicare for the first time, and my claim was denied for CO-16. I contacted Medicare and was told my claim was missing the appropriate modifier. Which modifier do I use?

A: When billing for a breast prosthesis, you must use either the RT (right) or LT (left) modifier. If the patient had a bilateral mastectomy, you must use both modifiers on one line item and your number of units should be two.

We invite readers to ask any questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact:lisa@westernmediallc.com.

Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for over a decade.

Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.