Billing and Collections Q&A

Home > Articles > Billing and Collections Q&A
By Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. Count on "Got FAQs?" to help you sort through the complexities associated with O&P billing. This month's column addresses your questions about O&P licensure or certification requirements for billing Medicare and submitting Medicare redetermination requests.

Q: I am an O&P provider in Mississippi. Are you aware of any change requirements that may have been made recently by Medicare regarding licensure for Mississippi providers? I am unable to locate where I saw this. I work alone and find it extremely difficult to keep up with all of Medicare's changes.

A: On August 2, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 2755, which lists five additional states that require the use of a licensed or certified orthotist or prosthetist to furnish O&P. These states are Arkansas, Georgia, Kentucky, Mississippi, and Tennessee. The effective date is October 5, 2013. This transmittal is based on Change Request (CR) 8390, which instructs the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to revise programming edits so that these five additional states are added to the logic, in accordance with CR 3959 (originally issued on August 19, 2005). CR 3959 instructed DME MACs to implement claims processing edits to ensure compliance with CMS regulations that require durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers who wish to bill Medicare to operate their business and to furnish Medicare-covered items in compliance with all applicable federal and state licensure and regulatory requirements.

When the original change was issued, there were nine states that required the use of a licensed or certified orthotist or prosthetist to furnish O&P: Alabama, Florida, Illinois, New Jersey, Ohio, Oklahoma, Rhode Island, Texas, and Washington. Since that time, Arkansas, Georgia, Kentucky, Mississippi, and Tennessee have instituted similar requirements. To view the change request, visit www.oandp.com/link/231

Q: We recently mailed five redetermination requests to Medicare. When I called Medicare to check the status, I was told it has nothing on file and I needed to resend everything. The customer service representative said I can fax this information. She was adamant that I follow all the instructions and submit the proper forms to have my claims reviewed. Can you please provide me with the fax number for Region C? What forms do I need to fill out, and where can I find them? Every time I speak to a representative, I receive a different answer.

A: CGS is the Region C DME MAC; the fax number is 615.782.4630. You need to fill out a redetermination request form for each request, which can be found at www.oandp.com/link/232. Since you are submitting multiple redetermination requests, you will also need a CGS Separator Sheet. Only use the Separator Sheet for sending in redetermination requests.

The Separator Sheet can be found at www.oandp.com/link/233; the page has a bar code on it with the letters CORR above. To ensure you have everything you need the first time, access the redetermination checklist at www.oandp.com/link/234. Before you file a duplicate redetermination request, you should check the status of the original request. You can check the status of your redetermination using the interactive voice response (IVR) or myCGS Web Portal. For instructions on how to check the status of a redetermination, visit www.oandp.com/link/235

Lisa Lake-Salmon is the president of Acc-Q-Data, whichprovides billing, collections, and practice management software. She has been serving the O&P profession for more than a decade. We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact or 800.279.1865 visit www.acc-q-data.com