September 2005 Issue
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 recently billed Medicare for a prosthetic leg, and all the codes were paid for with the exception of Code L-5685. This claim is now pending as needing additional information. I can't seem to find out what information is needed for Medicare to pay. Please help, so I can get this code paid!
A: When Code L-5685 is billed, the claim must include a narrative description of the item, the manufacturer, and the model name or number (if applicable). By supplying this information to Medicare, your claim/code will be paid.
Q: I am located in Region C for Medicare and I have a claim that needs to go to fair hearing. I am not sure of the process for filing. Do you need a specific form? Is there a dollar amount limit? Please help, as this is the first time I am requesting a hearing.
A: The address for Region C ALJ (administrative law judge) hearings is: Palmetto GBA, PO Box 100106, Columbia, SC 29202-3106. Please note that you must submit a hearing form along with your information. You can obtain the hearing form (CMS-5011B) from the Medicare Region C website (www.cms.hhs.gov/forms/ cms5011A-B.pdf).
Your claim must be a minimum of $100. If your claim is under $100, you may combine multiple claims to meet the minimum amount in question for an ALJ appeal request. You must include, in your appeal request, the specific claims that are being aggregated. If your request does not state the designated claims that are being aggregated, each claim will be treated as a separate request and those not meeting the $100 minimum will be dismissed.
We invite readers to ask questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact:firstname.lastname@example.org
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