Accurate Billing Will Optimize Supplies/Orthotics Payment
Published on Wed Mar 01, 2000
Editors Note: Part one of this three-part series reviews strategies to simplify billing for supplies and orthotics. Over the next two months, part two will offer a closer look at billing selected supplies and orthotics for the extremities, and part three will consider the same for those supplies and orthotics used in treating and ameliorating conditions of the head, neck and torso.
Nugget: Confusion about how to bill has caused some orthopedic practices to lose the cost of supplies sent home with patients.
How do orthopedic practices view billing for supplies and orthotics? In most cases, they say they hate it, says Kathi Erickson, president of Innovative Health Services in Twinsburg, Ohio. The billing process will be improved if you know where and when to bill, who can bill and what to bill.
The Health Care Financing Administration Common Procedure Coding System (HCPCS) applies to medical and surgical supplies (A series), orthotics and prosthetics (L series) and durable medical equipment (E series). Carrier discretion and special coverage instructions for HCPCS codes are wide-ranging and highly variable.
Billing for supplies and orthotics has three problem areas.
1. Where and when to bill: Medicare requires claims for certain items to be submitted to the Durable Medical Equipment Regional Carrier (DMERC). Some claims, i.e, surgical dressings, such as A6206 (contact layer, 16 sq. in. or less, each dressing), are included as part of the professional service and cannot be submitted separately.
Yet if the same dressings are given to the patient to take home and use in home care, they can be billed (to the DMERC). Therein lies another layer of complexity for orthopedic practicesseparately inventorying supplies sent home with patients and used in the office.
2. Who can bill: Some items cannot be billed at all by an orthopedist. For example, an orthopedist may prescribe diabetic shoes and do the fitting and modifications, but a podiatrist, pedorthist, orthotist or prosthetist must do the fitting and furnishing.
Moreover, a separate Medicare category (of Medicare Part B) covers therapeutic shoes for patients with diabetes and specifies the calendar-year limits for shoes (custom molded and depth) and inserts. The physician in charge of diagnosing and documenting the diabetes must certify that the patient has diabetes. That physician or another qualified physician, i.e., an orthopedist, can write the prescription for the shoes. If the patient later needs a brace in addition to shoes, the brace is coded the way a corresponding brace for a person with any condition would be.
3. What to bill: There can be advantages to billing certain durable medical equipment as an orthotic device instead of durable medical equipment. And suppliers of wheelchairs to patients in skilled nursing [...]
