Reimbursement Q&A

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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 receive many requests to deliver items to patients while they are in the hospital, and I find I have a hard time being paid for these services by Medicare.

A: According to DMEPOS, you may deliver items to a patient during an inpatient stay at a hospital, as long as the delivery date is within two days prior to discharge and the item is needed for fitting and training purposes. When billing Medicare, your date of service should be the patient's discharge date, instead of date of delivery. Your place of service should either be 11 (office) or 12 (home). You should have all the proper documentation in the patient file to support this information.

Q: I sometimes make modifications to a prefabricated item to fit a patient's needs. Can I bill Medicare for labor or repair for this?

A: According to DMERC, a provider may only bill for time involved with the actual repair of an orthosis or prosthesis for medically necessary adjustments made more than 90 days after delivery.

Q: Can a provider have access to the history of a patient to determine if they have received same or similar items in the past?

A: A provider may contact the Caller Information Network (CIN) with the beneficiary on the line. If the beneficiary grants permission to release this information to you, then the Medicare representative can supply the patient's history to you.

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:

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 of Acc-Q-Data Inc.