BCBS of Maryland

BCBS of Maryland

Ted Trower

1/16/2004

My original question was:

We've recently processed a claim for an LSO for a client with coverage thru
BSBC of Maryland. The claim was rejected because the LSO was delivered in
our office rather than in the clients home. Is this a normal practice in
that region? Or is it that they want the place of service to reflect where
the orthosis will be used?

Replies Follow
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I had done the billing in an office in Pennsylvania and Maryland we always
used the delivery code of patients home. I believe the reason for using
this code is because that is where the patient will be using the orthosis.
I think the same rule applies to Medicare claims. I hope this helps, it has
been some time since I have done billing and my memory may be fuzzy. I do,
however, believe you can resubmit stating wrong code was used by mistake.

Good Luck

Wendy Miller, Boc Orthotist


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On all DME/O&P claims, the place of service is always 12 which is home.
All of my O&P is fit and delivered from or in the office, but you cannot
use the office as the place of service for home medical products. It
does not make a lot of sense, but that is how it works. I have my first
claims all rejected because of this issue. Once I corrected the place of
service, they went through just fine.


Jim DeWees, CP

-----------------------------------------------------------------------------------------------------------------
That sounds very strange. We have never experienced anything like
that. We've been denied if we fit in a different location than where we
bill from, but never for not delivering to their home??
Mark

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I believe what you are seeing is the first stage in competitive bidding/
Medicare changes. When I looked at a request from a physicians group for
stock and bill I found that Medicare considers any orthotic care provided in
the dr.
office to be a global service, thus your in office denial.

This answer came from region C palmetto(bcbs) .
You can appeal or call your Dme liaison with your carrier.

Jeff Arnette, LPO

=========================================================
End of replies.

The answer Jim gave sounds familiar but I cannot recall where I heard
it. We will investigate the issue further.

Thanks to all who replied!

Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA

www.amputee.com

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