Wiki Billing for Orthotics not picked up?

[hkost]

How are practices handling custom scanned orthotics that don't get picked up by the patient? Has anyone heard of billing with the additional information of "salvage" in box 19 and getting reimbursed for that?

 

[podcoder70]

What insurance did the patient have and is the patient still alive? moved away? didn't want them?

 

[hkost]

It's a mix of payers - and the patients just don't return calls or stop in to pick up the custom orthotics. They don't cancel the order, move away or pass away. We can't use them for anyone else as they were custom fitted so we're trying to cover time and supplies used with out additional expenses. We don't have a proof of delivery or signature the patient received them as they won't respond to requests to come in and pick them up so we can't bill the insurance.

 

[podcoder70]

I gotcha. Okay, the salvage claim definition from Medicare is as follows:

Medicare will reimburse the provider/supplier in three specific circumstances:
1. Death of the beneficiary
2. Cancellation of the order by the beneficiary (ie. moved away from the area)
3. A change in medical necessity for the item such that it is no longer suitable for the beneficiary’s medical condition
So not picking them up would not qualify for the salvaged claim in my opinion. In my 23 years in Podiatry management and billing, I have never billed a salvaged claim.

APMA CRC weighed in on this subject and there were a number of opinions. Most notable was from Harry Goldsmith DPM. He said the following:
"I am not aware of any written requirements by commercial payers that providers follow Medicare’s dispensing/billing process. Over the years, the “Medicare” policy has frequently become the uniform office policy of foot and ankle practices (i.e., bill the payer at the time orthotics are dispensed). If you want to do otherwise, you should check with the individual payer first to ensure you are not violating contractual policy. Personally, I would recommend adopting the Medicare dispensing/billing policy. At the same time I would echo those who recommend taking a deposit from patients with commercial plans (this presumes there is no contract language prohibiting deposits). The deposit can be refunded (minus patient contract obligations) if the commercial plan denies payment for the orthotics."

Some payers want the orthotics billed at the time of casting (California Medicaid for example). Check with your payers to see if they have a policy. If they don't have a policy, bill it out with casting date of service.

If you haven't already billed out the "casting", you should do so, this will help you recoup some of the cost of the orthotics. Some payers recognize 29799, others S0395. Bill it on 2 lines with RT and LT modifiers. I do this on all orthotics with the exception of cash pay.

For future orthotics, I recommend collecting a deposit that covers lab costs regardless of the insurance. Then, if the patient doesn't come back, you have at least covered the lab fees. Also, just for curiosity sake, what code are you billing for orthotics?

 

[avidsky]

I gotcha. Okay, the salvage claim definition from Medicare is as follows:

Medicare will reimburse the provider/supplier in three specific circumstances:
1. Death of the beneficiary
2. Cancellation of the order by the beneficiary (ie. moved away from the area)
3. A change in medical necessity for the item such that it is no longer suitable for the beneficiary’s medical condition
So not picking them up would not qualify for the salvaged claim in my opinion. In my 23 years in Podiatry management and billing, I have never billed a salvaged claim.

APMA CRC weighed in on this subject and there were a number of opinions. Most notable was from Harry Goldsmith DPM. He said the following:
"I am not aware of any written requirements by commercial payers that providers follow Medicare’s dispensing/billing process. Over the years, the “Medicare” policy has frequently become the uniform office policy of foot and ankle practices (i.e., bill the payer at the time orthotics are dispensed). If you want to do otherwise, you should check with the individual payer first to ensure you are not violating contractual policy. Personally, I would recommend adopting the Medicare dispensing/billing policy. At the same time I would echo those who recommend taking a deposit from patients with commercial plans (this presumes there is no contract language prohibiting deposits). The deposit can be refunded (minus patient contract obligations) if the commercial plan denies payment for the orthotics."

Some payers want the orthotics billed at the time of casting (California Medicaid for example). Check with your payers to see if they have a policy. If they don't have a policy, bill it out with casting date of service.

If you haven't already billed out the "casting", you should do so, this will help you recoup some of the cost of the orthotics. Some payers recognize 29799, others S0395. Bill it on 2 lines with RT and LT modifiers. I do this on all orthotics with the exception of cash pay.

For future orthotics, I recommend collecting a deposit that covers lab costs regardless of the insurance. Then, if the patient doesn't come back, you have at least covered the lab fees. Also, just for curiosity sake, what code are you billing for orthotics?

Thank you for this information. I also found the APMA article you referred to; I wish there was a more current one.

Do you by chance have any Medi-Cal or especially Healthnet policy documents I can refer to regarding billing orthotics at time of casting vs when dispensed?

 

[podcoder70]

I don't have anything in writing for Medi-Cal. In Northern California, it is Partnership Health Plan. When they first came into the picture, there were issues with billing for orthotics and they told us that to get paid for casting, 29799 it had to be billed with the orthotics. There was a lot of discussion and back an forth verbally and by email, but I did not keep any of those. If your Medi-Cal is administered by Health Net, how do they want their TARs to look? Partnership Health Plan is very specific: L3000 RT, L3000 LT, 29799 51 RT, 29799 51 LT, 29799 UA. Depending on the contract, they pay very well.
I want to go back to my original answer...I shared info on "salvage" claim...I think because you had originally asked for salvage claim info. It really has no bearing on your question, though, because custom orthotics are not covered by Medicare.

Bottom line, with the exception of Medi-Cal, collect a deposit at time of casting for all patients, minimum of $150. I have no problem getting patients to pay that. Then, at the very least, your lab fees are paid.