Billing Question
Jessica Fachini
Description
Collection
Title:
Billing Question
Creator:
Jessica Fachini
Date:
8/30/2007
Text:
I have a patient who has a Medicare HMO. She has been fit with her
preparatory prosthesis that included a foot. I am now in the process of
pre-certifying her definitive style prosthesis. Her HMO is denying the
any type of foot, stating that since she received one on her preparatory
they will not approve another for her definitive and for us to just
re-use the foot from the preparatory.
I was told once that it was against Medicare regulations to bill for a
re-used component. I will be billing for a new foot considering the
base code of her definitive prosthesis includes a Sach foot. I am
trying to write my appeal and I would like to include proof of the
Medicare regulation. Does anyone know where I can find that rule in
writing or if it even exists? I have checked the CMS website as well as
my DME MAC website. I have even tried to Google it with no luck.
Jessica Fachini
Prosthetics Billing Administrator
The Surgical Clinic, PLLC
preparatory prosthesis that included a foot. I am now in the process of
pre-certifying her definitive style prosthesis. Her HMO is denying the
any type of foot, stating that since she received one on her preparatory
they will not approve another for her definitive and for us to just
re-use the foot from the preparatory.
I was told once that it was against Medicare regulations to bill for a
re-used component. I will be billing for a new foot considering the
base code of her definitive prosthesis includes a Sach foot. I am
trying to write my appeal and I would like to include proof of the
Medicare regulation. Does anyone know where I can find that rule in
writing or if it even exists? I have checked the CMS website as well as
my DME MAC website. I have even tried to Google it with no luck.
Jessica Fachini
Prosthetics Billing Administrator
The Surgical Clinic, PLLC
Citation
Jessica Fachini, “Billing Question,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/228477.
