Reply summary: Medicare and MPKs
Description
Collection
Title:
Reply summary: Medicare and MPKs
Date:
4/16/2015
Text:
-----Original Message-----
From: <Email Address Redacted> [mailto:<Email Address Redacted>]
Sent: Monday, March 23, 2015 06:32 PM
To: <Email Address Redacted>
Subject: Medicare and MPKs
Has anyone been successful in getting paid by Medicare for a Microprocessor Controlled Knee without going thru the entire spectrum of the appeal process?
Replies follow
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
5-10 MPK's per year for last 5 years w no audits on front or back end.
-------------------------------------------------------------------------------------------------------------------
Yes, we are. Some do go through audits but we are getting paid for both MPK and MPF's.
-------------------------------------------------------------------------------------------------------------------
Please share responses.
-------------------------------------------------------------------------------------------------------------------
Not recently Ted....in the middle of another one now post pre-payment review....
grrrrr.
-------------------------------------------------------------------------------------------------------------------
Yes my last mpk with Medicare was paid in 3weeks no appeals needed. But rest assure I have a mountain of documentation if needed
-------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------
We got paid last May in full for a C leg. Had great documentation, but it wasn't audited. Mc + AARP
-------------------------------------------------------------------------------------------------------------------
Gotta love our improved healthcare! Yes, I billed and was paid for 3 Symbionic Legs last year through Medicare. Sent my supporting documentation and paid 45 days later.
-------------------------------------------------------------------------------------------------------------------
We've had one prosthesis denied... Dumbass MD and our oversight and learning curve. That's my only denial, and that is two years old this may. I am practicing at 100% coverage on first round of request of supporting/additional information.
-------------------------------------------------------------------------------------------------------------------
I have, and it was based on the physicians chart notes detailing a solid k3 functional level.....or so I think. I got Paid and they haven't taken it back. I have another new ak in the pipeline that is headed that direction but won't be ready for the definitive for a couple more months.
-------------------------------------------------------------------------------------------------------------------
I'm in region C and we have never had a MPK audited. We are very picky about who gets them and probably do around 8-10 a year. So maybe we don't do enough to get noticed.
-------------------------------------------------------------------------------------------------------------------
In my billing experience, in the last 3 years- no I have not had any microprocessors knees covered by medicare w/out going through the appeals process. In fact my former O&P firm hired legal counsel for the appeals. With the process backed up for at least 24 months- I don't know if they will ever get paid.
Basically, Medicare's justification is- if they are on Medicare-they have no need for a microprocessor knee. Not that I agree with that- but we are forced to bill according to what we know the insurance will cover, unless the patient is willing to pay for item.
I hope this helps.
-------------------------------------------------------------------------------------------------------------------
Im in region D. But they audit most all of them now.
-------------------------------------------------------------------------------------------------------------------
Ted can you post some answer's? ..thx
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
From: <Email Address Redacted> [mailto:<Email Address Redacted>]
Sent: Monday, March 23, 2015 06:32 PM
To: <Email Address Redacted>
Subject: Medicare and MPKs
Has anyone been successful in getting paid by Medicare for a Microprocessor Controlled Knee without going thru the entire spectrum of the appeal process?
Replies follow
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
5-10 MPK's per year for last 5 years w no audits on front or back end.
-------------------------------------------------------------------------------------------------------------------
Yes, we are. Some do go through audits but we are getting paid for both MPK and MPF's.
-------------------------------------------------------------------------------------------------------------------
Please share responses.
-------------------------------------------------------------------------------------------------------------------
Not recently Ted....in the middle of another one now post pre-payment review....
grrrrr.
-------------------------------------------------------------------------------------------------------------------
Yes my last mpk with Medicare was paid in 3weeks no appeals needed. But rest assure I have a mountain of documentation if needed
-------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------
We got paid last May in full for a C leg. Had great documentation, but it wasn't audited. Mc + AARP
-------------------------------------------------------------------------------------------------------------------
Gotta love our improved healthcare! Yes, I billed and was paid for 3 Symbionic Legs last year through Medicare. Sent my supporting documentation and paid 45 days later.
-------------------------------------------------------------------------------------------------------------------
We've had one prosthesis denied... Dumbass MD and our oversight and learning curve. That's my only denial, and that is two years old this may. I am practicing at 100% coverage on first round of request of supporting/additional information.
-------------------------------------------------------------------------------------------------------------------
I have, and it was based on the physicians chart notes detailing a solid k3 functional level.....or so I think. I got Paid and they haven't taken it back. I have another new ak in the pipeline that is headed that direction but won't be ready for the definitive for a couple more months.
-------------------------------------------------------------------------------------------------------------------
I'm in region C and we have never had a MPK audited. We are very picky about who gets them and probably do around 8-10 a year. So maybe we don't do enough to get noticed.
-------------------------------------------------------------------------------------------------------------------
In my billing experience, in the last 3 years- no I have not had any microprocessors knees covered by medicare w/out going through the appeals process. In fact my former O&P firm hired legal counsel for the appeals. With the process backed up for at least 24 months- I don't know if they will ever get paid.
Basically, Medicare's justification is- if they are on Medicare-they have no need for a microprocessor knee. Not that I agree with that- but we are forced to bill according to what we know the insurance will cover, unless the patient is willing to pay for item.
I hope this helps.
-------------------------------------------------------------------------------------------------------------------
Im in region D. But they audit most all of them now.
-------------------------------------------------------------------------------------------------------------------
Ted can you post some answer's? ..thx
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Citation
“Reply summary: Medicare and MPKs,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237218.
