October 2006 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: We are a custom manufacturer of various ligamentous and osteoarthritic knee orthoses. While most L-Codes are easily sourced for ACL or similar knee braces, we are having a harder time sourcing out a code for one of our newest designs. We are trying to figure out if this particular brace can be coded as a ligamentous knee brace. Any help or advice would be appreciated.
A: SADMERC conducts reviews of products to determine the correct HCPCS codes for Medicare billing. You will need to fill out a HCPCS coding verification request for orthotics. The form may be accessed at www.palmettogba.com. Under "Other Partners," click on "SADMERC," and this will bring you to the home page where you will find the application.
Q: Can you tell me if there is a form that a Medicare patient would need to sign if he or she cannot pay the portion of the bill that insurance does not cover?
A: Medicare law requires that on assigned claims, there must be an attempt on the part of the supplier to collect from the patient any deductible amount applied to the claim and the 20 percent coinsurance. The supplier does not generally waive payment of these, but will do so on occasion based on the patient's limited financial condition or inability to pay. According to DMERC, there is no specific form for this situation. There are various sources, though, for sample "Waiver of Payment Due to Economic Hardship" forms that you can have the patient complete and keep on file.
Q: Can you tell me whether or not Medicare will pay for a pair of diabetic shoes if one side is an above-knee or below-knee amputation?
A: As long as the patient's medical condition meets the requirement for diabetic shoes, then, yes, Medicare would cover this. Since diabetic shoes are billed as a pair, it does not matter if the patient is an amputee or not.
We invite readers to ask questions regarding billing, collections, or related subjects. For more information, contact firstname.lastname@example.org . Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.