Is there room for error when billing for orthotics and prosthetics?
Medicare 101: Get to Know the Basics The perfect webinar for the new hire, or if you want a refresher. This webinar will provide an overview of the Medicare program and how it relates to O&P care. Learn about the different parts of Medicare and how certain payment structures are created. Register: April 13, 2022: Clinicians Corner-Techs/Fitters
What are the requirements to be a prosthetic and orbital device provider?
Medicare Claims Processing Manual Chapter 20 - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Table of Contents (Rev. 10840, 06-11-21) Transmittals for Chapter 20. 01 - Foreword . 10 - Where to Bill DMEPOS and PEN Items and Services . 10.1 - Definitions . 10.1.1 - Durable Medical Equipment (DME)
Who does HCA reimburse for providing Prosthetic and orthotic (P&O) devices?
We Need Your Help, Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in Senate. Hopefully you saw that late last week, the Medicare O&P Patient-Centered Care Act (S. 2556) was introduced in the Senate. This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care while simultaneously ...
What is the code for prosthetic and orthotic devices?
Medicare O&P: What You Need to Document to Avoid Denials Documentation Seminar The American Academy of Orthotists and Prosthetists (AAOP), one of AOPA’s O&P Alliance partners, is hosting a live webinar with the American Academy of …
We Need Your Help, Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in Senate
Hopefully you saw that late last week, the Medicare O&P Patient-Centered Care Act (S. 2556) was introduced in the Senate. This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care while simultaneously ...More
Medicare O&P Patient-Centered Care Act Introduced in House, Urge Your Representative to Support
On March 17, the House introduced the Medicare O&P Patient-Centered Care Act (HR 1990). This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care while simultaneously combating fraud and abuse. The b ...More
Advocacy Webinar TODAY 1:00 p.m. ET
Look forward to seeing everyone on today's advocacy webinar. I promise not to put you to sleep by describing the procedural minutiae that Congress will use to pass the next COVID package. Register here!
January Advocacy Webinar
Join Justin Beland, AOPA's Director of Government Affairs for the first AOPA Monthly Member Advocacy Webinar of 2021 on Wednesday, January 27 at 1pm ET. In addition to getting an update on AOPA's 2021 legislative priorities and what to expect from th ...More
What's Ahead on Capitol Hill and in the Administration in 2021?
To find out, join Justin Beland, AOPA's Director of Government Affairs for the next AOPA Monthly Member Advocacy Webinar on Wednesday, December 16 at 1pm ET. In addition to hearing what to expect in 2021, you'll get the tools to help you deliver a po ...More
Obtaining a Provider Number
If you want to receive reimbursement from a Durable Medical Equipment Regional Carrier (DMERC), then you have to provide your number—your DMEPOS number, that is. Not to be confused with your NPI number, your DMEPOS number is required to receive reimbursement for items like splints, orthotics, and other supplies.
Picking the Right Codes
There are several different codes providers can use to bill for orthotics, prosthetics, and DMEs—and it’s absolutely crucial that you pick the right one.
Obtaining Reimbursement
Now, on to the good stuff: getting paid. There’s a lot at play here, so let’s dissect what, exactly, payers are reimbursing you for during these interventions. (Note: The information below refers to how Medicare reimburses for prosthetics and orthotics and does not necessarily reflect how commercial payers reimburse for these interventions.
Renting or Selling DME
If your patient decides to rent or purchase a DME item, your DMERC will want to know. You can inform your DMERC of the patient’s decision by including one of the following modifiers on the claim:
Proving Medical Necessity
For certain items, the DMERC requires a certificate of medical necessity (CMN). Each DMERC has its own list of items requiring a CMN, but these lists typically include the following items:
Billing for TENS Units
Billing for TENS units is little tricker than billing for other pieces of DME. In fact, it can even be difficult to receive reimbursement for TENS units, with nearly half of all claims for TENS units being denied. The number-one reason for those denials? Incorrect billing procedure.
What is the phone number for HCA?
HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call 1-800-562- 3022. People who have hearing or speech disabilities, please call 711 for relay services.
What is Apple Health in Washington State?
Washington Apple Health is the name used in Washington State for Medicaid, the children’s health insurance program (CHIP), and state-only funded health care programs. Washington Apple Health is administered by the Washington State Health Care Authority. Refer also to HCA’s . ProviderOne billing and resource guide for valuable information ...
Is CPT a trademark?
CPT is a registered trademark of the AMA. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.