Same or Similar for Medicare patients
Tracy Fields, Billing Specialist
Description
Collection
Title:
Same or Similar for Medicare patients
Creator:
Tracy Fields, Billing Specialist
Date:
5/25/2018
Text:
Good morning to everyone! I am hoping someone might be able to provide some
insight to the same or similar search with Medicare. I am not sure if this
option just does not work appropriately or if the user (myself) does not
understand how to function this search.
I have yet to have anything come back aside from an error in using the
search field in Zirmed. I have researched Zirmed tools to advise if using
properly and discovered that some HCPCS codes do not show properly and
suggest using either mycgs or the IVR. I have used both and am not able to
ever get a response on either. I even used a patients claim that denied
specifically for same or similar and it would still come back as no CMN
status found. I can search claim history and pull up every Lcode billed but
how do I determine if they will consider something as same or similar. I
know some of it is common sense but we deal with a lot of orthotics such as
AFO's and knee braces which can turn into high dollar differences. My
thought process at this moment is that if it is a downgrade then obviously
that would be considered same or similar but if you are upgrading due to
the previous not helping will it deny out as same or similar or not? Or as
we commonly have when a patient receives a brace of some sort and then get
rid of it before the lifespan is over and the doc prescribes another but not
the exact same. HELP!!!
I find this very frustrating both for my company as well as the patient
because we are not able to properly confirm if there will be an issue with
their claim or not and therefore we are losing money or they are not moving
forward with services that they need due to the fear of being billed later
for it. As I am sure it is the same in most places our Medicare patients are
typically on limited incomes and do not need unexpected costs added.
I am just trying to find out if I am the only one that finds this function
completely useless or if I am the one that just does not understand how to
properly find what I am looking for. Any advise would be greatly
appreciated.
Thank you
Tracy Fields
Billing Manager
First Step Prosthetics
1136 US 31W Bypass, Bowling Green, KY 42101
Phone 270.904.6130 / Fax 270.721.0749
Email: <mailto:<Email Address Redacted>>
<Email Address Redacted>
Web: < <URL Redacted>> www.firststepprosthetics.com
This facsimile/email transmission contains information, which is
confidential and/or privileged. This information is intended for use only by
the addressee indicated above. If you are not the intended recipient, please
be advised that any disclosure, copying, distribution, or use of the
contents of this information is strictly prohibited, and that any
misdirected or improperly received information must be returned to this
company immediately. Your cooperation in contacting the sender regarding the
erroneous receipt is requested.
insight to the same or similar search with Medicare. I am not sure if this
option just does not work appropriately or if the user (myself) does not
understand how to function this search.
I have yet to have anything come back aside from an error in using the
search field in Zirmed. I have researched Zirmed tools to advise if using
properly and discovered that some HCPCS codes do not show properly and
suggest using either mycgs or the IVR. I have used both and am not able to
ever get a response on either. I even used a patients claim that denied
specifically for same or similar and it would still come back as no CMN
status found. I can search claim history and pull up every Lcode billed but
how do I determine if they will consider something as same or similar. I
know some of it is common sense but we deal with a lot of orthotics such as
AFO's and knee braces which can turn into high dollar differences. My
thought process at this moment is that if it is a downgrade then obviously
that would be considered same or similar but if you are upgrading due to
the previous not helping will it deny out as same or similar or not? Or as
we commonly have when a patient receives a brace of some sort and then get
rid of it before the lifespan is over and the doc prescribes another but not
the exact same. HELP!!!
I find this very frustrating both for my company as well as the patient
because we are not able to properly confirm if there will be an issue with
their claim or not and therefore we are losing money or they are not moving
forward with services that they need due to the fear of being billed later
for it. As I am sure it is the same in most places our Medicare patients are
typically on limited incomes and do not need unexpected costs added.
I am just trying to find out if I am the only one that finds this function
completely useless or if I am the one that just does not understand how to
properly find what I am looking for. Any advise would be greatly
appreciated.
Thank you
Tracy Fields
Billing Manager
First Step Prosthetics
1136 US 31W Bypass, Bowling Green, KY 42101
Phone 270.904.6130 / Fax 270.721.0749
Email: <mailto:<Email Address Redacted>>
<Email Address Redacted>
Web: < <URL Redacted>> www.firststepprosthetics.com
This facsimile/email transmission contains information, which is
confidential and/or privileged. This information is intended for use only by
the addressee indicated above. If you are not the intended recipient, please
be advised that any disclosure, copying, distribution, or use of the
contents of this information is strictly prohibited, and that any
misdirected or improperly received information must be returned to this
company immediately. Your cooperation in contacting the sender regarding the
erroneous receipt is requested.
Citation
Tracy Fields, Billing Specialist, “Same or Similar for Medicare patients,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/208944.
