Medicare Billing by Institutional O&P Practices
Mark Seibel
Description
Collection
Title:
Medicare Billing by Institutional O&P Practices
Creator:
Mark Seibel
Date:
11/30/2006
Text:
We are an O& P practice contained within a very large rural acute care
hospital. We service inpatients as well as outpatients. We are fully
owned by the hospital and bill the Medicare fiscal intermediary (FI) for
most of our services, using a UB-92 form. Unfortunately, the FI does
not reimburse for the diabetic shoe codes, so several years ago we
obtained a Medicare provider number and have been billing the DMERC and
now the DMAC for these codes, using a HCFA 1500 form.
We have recently been told by the Medical Director of Region A DMAC
that we can no longer do this. He states that since we are owned by the
hospital, we are required to only bill the FI. The only way that we
could bill the DMAC would be if we were incorporated as a separate
business owned by the hospital. If that were the case, we would be
unable to bill the FI and would be required to bill all our items to the
DMAC on a 1500 form. In other words, you can bill one (FI) or the other
(DMAC).
Is there anyone else out there in a similar situation? I have tried in
vain to find a written policy addressing this situation. I would
appreciate any insight. Thank you.
Mark Seibel CPO
IMPORTANT WARNING: The information in this message (and the documents attached to it, if any) is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken, or omitted to be taken, in reliance on it is prohibited and may be unlawful. If you have received this message in error, please delete all electronic copies of this message (and the documents attached to it, if any), destroy any hard copies you may have created and notify me immediately by replying to this email. Thank you.
hospital. We service inpatients as well as outpatients. We are fully
owned by the hospital and bill the Medicare fiscal intermediary (FI) for
most of our services, using a UB-92 form. Unfortunately, the FI does
not reimburse for the diabetic shoe codes, so several years ago we
obtained a Medicare provider number and have been billing the DMERC and
now the DMAC for these codes, using a HCFA 1500 form.
We have recently been told by the Medical Director of Region A DMAC
that we can no longer do this. He states that since we are owned by the
hospital, we are required to only bill the FI. The only way that we
could bill the DMAC would be if we were incorporated as a separate
business owned by the hospital. If that were the case, we would be
unable to bill the FI and would be required to bill all our items to the
DMAC on a 1500 form. In other words, you can bill one (FI) or the other
(DMAC).
Is there anyone else out there in a similar situation? I have tried in
vain to find a written policy addressing this situation. I would
appreciate any insight. Thank you.
Mark Seibel CPO
IMPORTANT WARNING: The information in this message (and the documents attached to it, if any) is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken, or omitted to be taken, in reliance on it is prohibited and may be unlawful. If you have received this message in error, please delete all electronic copies of this message (and the documents attached to it, if any), destroy any hard copies you may have created and notify me immediately by replying to this email. Thank you.
Citation
Mark Seibel, “Medicare Billing by Institutional O&P Practices,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/227604.
