Reply summary: Medicare repair charges
Description
Collection
Title:
Reply summary: Medicare repair charges
Date:
2/6/2014
Text:
My original question was:
What has your experience been when billing out-of-warrantee
repairs for microprocessor controlled knees?
Replies follow:
--------------------------------------------------------
We have had great success in billing the out of warranty
repairs on microprocessor knees. If it is OB, you have to
list each line item (or part) separately using L7510 and the
most critical part is the description that goes on the line.
For example, RPL spacer xxx manuf part# xxxx as part of RPR
of L5856.
--------------------------------------------------------
Only experience is with pylon for CLeg. Payor wouldn't
accept Otto Bock suggested code. We ended up negotiating
price and using L5999 code. Good luck,
--------------------------------------------------------
We do it frequently with success. You will need the
manufacturer repair invoice and thorough documentation. The
physician must document the medical necessity of the repair.
So make sure that the patient sees their doctor and the
doctor does so. These generally always go through
pre-payment review so it will go through much smoother if
everything is in line. They require you to document an
itemization of the labor that was involved and the parts,
including the manufacturer and part numbers. They will ask
for documentation of medical necessity, catalog or product
pictures of the item being repaired, etc. It will take a
bit of time to get paid on these but it can be done!
--------------------------------------------------------
We've been denied any labor charges that exceed 8 units (two
hours) I fought all the way through to the ALJ level for
someone I had 5 hours repair time on, and won. It took 18
mos. Next time we tried to bill over 8 units, same problem.
I can't fight them all. I have to bill the labor on
multiple DOS to get paid for what was needed and provided.
--------------------------------------------------------
Thank you to all who replied!
Ted A. Trower CPO,
A-S-C Orthotics & Prosthetics
Jackson, MI
www.amputee.com
What has your experience been when billing out-of-warrantee
repairs for microprocessor controlled knees?
Replies follow:
--------------------------------------------------------
We have had great success in billing the out of warranty
repairs on microprocessor knees. If it is OB, you have to
list each line item (or part) separately using L7510 and the
most critical part is the description that goes on the line.
For example, RPL spacer xxx manuf part# xxxx as part of RPR
of L5856.
--------------------------------------------------------
Only experience is with pylon for CLeg. Payor wouldn't
accept Otto Bock suggested code. We ended up negotiating
price and using L5999 code. Good luck,
--------------------------------------------------------
We do it frequently with success. You will need the
manufacturer repair invoice and thorough documentation. The
physician must document the medical necessity of the repair.
So make sure that the patient sees their doctor and the
doctor does so. These generally always go through
pre-payment review so it will go through much smoother if
everything is in line. They require you to document an
itemization of the labor that was involved and the parts,
including the manufacturer and part numbers. They will ask
for documentation of medical necessity, catalog or product
pictures of the item being repaired, etc. It will take a
bit of time to get paid on these but it can be done!
--------------------------------------------------------
We've been denied any labor charges that exceed 8 units (two
hours) I fought all the way through to the ALJ level for
someone I had 5 hours repair time on, and won. It took 18
mos. Next time we tried to bill over 8 units, same problem.
I can't fight them all. I have to bill the labor on
multiple DOS to get paid for what was needed and provided.
--------------------------------------------------------
Thank you to all who replied!
Ted A. Trower CPO,
A-S-C Orthotics & Prosthetics
Jackson, MI
www.amputee.com
Citation
“Reply summary: Medicare repair charges,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236085.
