Medicare and post op casts
Karl Entenmann
Description
Collection
Title:
Medicare and post op casts
Creator:
Karl Entenmann
Date:
12/14/2004
Text:
To my esteemed colleagues,
I recently provided immediate post op BK cast procedures to two patients who are now in skilled nursing facilities. Both are in the SNFs under Medicare part A. I requested POs on both patients and was told that I had to bill Medicare B for the cast changes because according to the list that the SNFs have from medicare,
<URL Redacted>
the following L codes are to be billed directly to Medicare, even though the patient is in the SNF under Medicare part A:
L5400 to L5460
The reference states that the SNF cannot bill Medicare for reimbursement for these codes.
I believe that means that these codes are simply part of the PPS package that the SNF gets paid for the patient and that they cannot bill Medicare for additional money if I provide that service in the SNF. They still have to pay me but cannot request additional payment from Medicare for paying me. The SNF says that what the reference means is that since they cannot be reimbursed, it is my responsibility to bill Medicare.
I participated in the AOPA SNF phone conference November 30, and in the list of items that were excluded from SNF PPS billing (excluded items can be billed to Medicare when the patient is under part A) these codes (L5400 to L5460) are not on the list and therefore must be billed to the SNF.
So, do I bill Medicare? Or what do I tell the SNF to help them understand this better and pay me.
Thanks
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA
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I recently provided immediate post op BK cast procedures to two patients who are now in skilled nursing facilities. Both are in the SNFs under Medicare part A. I requested POs on both patients and was told that I had to bill Medicare B for the cast changes because according to the list that the SNFs have from medicare,
<URL Redacted>
the following L codes are to be billed directly to Medicare, even though the patient is in the SNF under Medicare part A:
L5400 to L5460
The reference states that the SNF cannot bill Medicare for reimbursement for these codes.
I believe that means that these codes are simply part of the PPS package that the SNF gets paid for the patient and that they cannot bill Medicare for additional money if I provide that service in the SNF. They still have to pay me but cannot request additional payment from Medicare for paying me. The SNF says that what the reference means is that since they cannot be reimbursed, it is my responsibility to bill Medicare.
I participated in the AOPA SNF phone conference November 30, and in the list of items that were excluded from SNF PPS billing (excluded items can be billed to Medicare when the patient is under part A) these codes (L5400 to L5460) are not on the list and therefore must be billed to the SNF.
So, do I bill Medicare? Or what do I tell the SNF to help them understand this better and pay me.
Thanks
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA
---------------------------------
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Citation
Karl Entenmann, “Medicare and post op casts,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/224040.
