Re: Medicare question

Re: Medicare question

JAMES M MCCOY

7/9/2001

Mr Mc Farland,

I found your letter and Kathy Dodson's response very interesting;
however, it appears to me that Medicare policy should not have any
relevance in this case unless you billed Medicare under part B. I assume
you billed the hospital. If so, the hospital is the provider and
therefore is responsible for any follow up services. I realize that this
could be interpreted as uncaring/unprofessional, but that is my
understanding of Medicare's regulations. The beneficiary has the choice
of coming to your office or returning to the Medicare provider (hospital)
for follow up service. If he chooses to visit your office for follow up,
I believe you could bill Medicare part B (if you choose to do so). It
would be interesting to read Ms. Dodson's opinion on this technicality.

James M. Mc Coy, C.P., L.P., FAAOP


 Hello List members-
> For your perusal, I am posting a question I sent to Kathy Dodson,
> followed
> by her answer:
> QUESTION:
> Hi Kathy,
> I performed the fitting of an LS corset to a patient and billed
> the
> hospital and now the patients is wanting me to come to his house to
> make
> adjustments.
> Am I prohibited from charging the patient for an out of office
> visit?
> (As opposed to the normal included follow up care that is included)
>
> If I am prohibited from the out of office visit charge, is
> there a
> limit to the distance that I am expected to travel to give this
> included
> care?
> How long after the hospital fitting must this included care
> continue?
> (I understand that if there's a change in the patient's condition I
> can
> charge for additional services.)
> Does it matter if the original service was out of office or in
> office?
> What if the patient decides they don't want to come in for
> follow up and
> insist that I do a home visit?
> Do you have a FAQ page to address the issues you've already
> answered?
>
> Thanks, Kathy
>
>
> Randy McFarland, CPO
>
> PS With your permission, I'll post your answer to the list server.
>
> ANSWER:
> Under Medicare, when you deliver a device, you are prohibited from
> charging
> separately for any type of visit, since this program doesn’t
> recognize a
> separate professional fee for suppliers. This also means that you
> could not
> charge the patient for the visit, since Medicare considers that you
> have
> already been paid for it in the payment for the device.. However,
> if you see
> a patient but do not end up providing a device to that patient, then
> that
> visit should simply be considered as a non-covered service (since it
> is not
> included in the payment for a device) and you should be able to bill
> the
> patient. Medicare has never made any pronouncement on this
> situation, but
> that is AOPA’s interpretation. I don’t know how often this
> happens, but I
> understand that it is not too common.
>
> Medicare has also never addressed any distance limits since they
> don’t
> recognize any reimbursement for this separate service. Regarding
> time
> frames, the lower limb medical policy states that adjustments that
> are not
> caused by a change in condition or functional abilities must be made
> for 90
> days from the date of service at no charge. The other medical
> policies (e.g.
> AFO/TLSO, spinals, shoes) don’t make reference to a time frame,
> but I would
> recommend applying the same 90 day criteria. In addition, if an
> item is
> still under warranty, you cannot bill Medicare for repairs or
> replacements.
>
> The location of the original service does not affect charging for
> adjustments/repairs. If the patient refuses to come in, that
> unfortunately
> still does not make it a separately compensable visit.
>
> At this point, we don’t have a FAQ section on our web site, but we
> are
> redesigning it and hope to have something like this in the future.
> Hope this
> information is helpful. If you need anything else, let me know.
> Kathy
> PS. Fine to post this
>
>