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: In the April 2004 edition of The O&P EDGE, you answered a question involving billing Medicare for items that were delivered to the patient while he/she was in the hospital. My question to you is: What happens in the case of a patient being discharged and then going to a skilled nursing facility or assisted living facility? Do the same rules apply?

A: If a patient goes into a SNF (skilled nursing facility), their Medicare Part A coverage is in effect for 100 days from the date of admission. After the 100 days, their Medicare Part B takes effect, and therefore you would be able to bill Medicare for services. If the patient goes into an ALF (assisted living facility), they continue to have their Medicare part B in effect, and therefore you would be able to bill Medicare for your services without having to wait the 100 days. Therefore, if the patient is discharged from the hospital and goes into a SNF, you would not be paid.

Q: I'm an O&P provider and recently billed Medicare for the services that took place in the office, using a place of service code 11. My claims were denied with a denial code of CO-16. When I contacted Medicare, they informed me it was due to an incorrect place of service code. What did I do wrong, and how can I correct this with Medicare? Does my claim now have to go into review?

A: Anytime you bill Medicare for services in which the patient can take the item home and/or benefits from the services while at home, you must bill with a place of service code 12. The place of service code 11 is used more for procedures that are done in the office and/or hospital services. You do not have to send your claim into review because it was denied as CO-16 (Lacks Information for Adjudication); therefore, you would only need to submit a new claim to Medicare with the corrected information.

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 of Acc-Q-Data Inc.