Skip navigation
9

Latest Post

Össur R&R Webinar | 2017 So Far: Transition and the Effects on O&P

Posted by Linda Collins | February 10, 2017

2017 So Far: Transition and the Effects on O&P

Friday, February 17, 2017 | 12pm EST
Free to Össur R&R subscribers.

A new President; Republicans have taken control of both the House and Senate; the fight over health care reform - lots is happening, but how does this affect health care professionals who provide prosthetic and orthotic care for their patients? Listen to Össur R&R's first podcast of the year to learn what's happening, what might happen later this year, and how you can prepare for it. 

Register today »


Brought to you by GoToWebinar®® | Webinars Made Easy®

Previous posts

Feb/07/2017 On Second Thought ...

CMS withdraws a previous announcement on competitive bidding.​

Feb/06/2017 Recovery Auditor Contractor (RAC) Training

Recently, Performant Recovery announced they will be offering a series of educational webinars to introduce the Performant RAC team. The webinars are free of charge and open to all DMEPPOS suppliers. 

Feb/01/2017 Competitive Bidding Update: Round 2019

Medicare has announced a new round of competitive bidding. What products are included? When will it start? How does it affect you? Read this post to learn more.​

Jan/30/2017 The C2C Telephone Discussion: What is it and Should You Do It?

​What is the C2C telephone discussion? Is i​t something you should consider doing? Learn important info about this program from guest author Stephanie Morgan Greene of The Audit Team.

Jan/27/2017 Össur R&R Webinar on February 17, 2017

​A new President; Republicans have taken control of both the House and Senate; the fight over health care reform - lots is happening, but how does this affect health care professionals who provide prosthetic and orthotic care for their patients? Listen to R&R's first podcast of the year to learn what's happening, what might happen later this year, and how you can prepare for it.

Jan/20/2017 Medicare Proposed Rule Re. "Qualified Practitioners"

Medicare recently published a proposed rule addressing who is qualified to provide custom-fabricated orthotics and prosthetics. How does it affect you? What do you need to know? Read this post to learn more.

 

Jan/17/2017 Appeals and Complaints: Private Insurance Companies

You see a patient with private insurance, do an assessment and determine the most appropriate product to meet the patient’s needs. You call the insurance company for pre-authorization, get it, and then receive a denial of payment. What next?

Jan/12/2017 Online Training for O&P Billing and Administrative Staff

​Century College is offering O&P Office Specialist Courses for anyone already in the field or interested in learning more about O&P coverage, coding and reimbursement.

Jan/05/2017 Changes to the Structure of all LCDs Coming

The DME MACs have issued a joint announcement that they will be modifying the structure of all medical device LCDs. ​What are the changes? When are they occurring? How will they affect you? Everything you need to know is in this R&R post.

Dec/29/2016 Recap: What Trends to Watch in O&P Reimbursement 2017

​A recent Össur R&R webinar

Dec/20/2016 New Knee Brace Codes and Fee Schedule for 2017

​Effective January 1, 2017, the K codes, K0901 and K0902, used for the off the shelf version of knee braces are no longer valid. The codes are being replaced with new codes.​

Dec/15/2016 Orthotic and Prosthetic Office Specialist Courses

The Orthotic & Prosthetic Office Specialist course will
equip you with the specialized skills needed in an O&P
office

Dec/12/2016 Össur R&R Webinar: O&P Reimbursement Trends to Watch In 2017

Join us for an insightful discussion on trends and predictions for the O&P industry in 2017. Learn how this will impact your practice and what you can do to be prepared.

Dec/08/2016 Join OPGA & Össur for a FREE Webinar – Earn 1.5 CEUs

​Join OPGA and Össur's Justin Pratt, ABC CP for a webinar to learn about the latest innovation in prosthetic foot performance.

Dec/05/2016 What Trends to Watch In O&P Reimbursement 2017

Össur R&R Webinar​ December 19, 2016

Dec/01/2016 Medically Necessary Criteria for Ankle and Knee Braces

In order for an item to be considered for coverage by Medicare, it must be “reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member…” The Local Coverage Decisions (LCDs) give detailed information about medical necessity requirements for various types of braces​

Nov/29/2016 Request a Telephone Discussion on Claims Appeals

​C2C Innovative Solutions, the Qualified Independent Contractor (QIC), has been testing a way to get claims in appeal at the ALJ level resolved. 

Nov/22/2016 Say Good Bye to the K Codes for Knee Braces

Effective January 1, 2017, the K codes, K0901 and K0902, used for the off the shelf version of knee braces are no longer valid. 

Nov/15/2016 Medically Necessary Criteria for Spinal Braces

​In order for an item to be considered for coverage by Medicare, it must be "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member…" The Local Coverage Decisions (LCDs) give detailed information about medical necessity requirements for various types of braces.

Nov/10/2016 Webinar Addressing the Effects of Trump's Win on O&P

​NAAOP is hosting a webinar that includes Össur R&R's David McGill. 

Nov/08/2016 All About ABNs

​Advance Beneficiary Notice of Noncoverage (ABN) is a form used to notify patients when Medicare may deny payment for an item or service.  Medicare has requirements on when and how to use an ABN.​

Nov/04/2016 New RAC Auditor for Orthotics and Prosthetics

​This week, Medicare announced the new contracts for Recovery Audit Contractors (RACs.) ​

Nov/02/2016 Lower Limb Prosthetic Covers

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have received a high volume of submitted claims for lower limb prosthetic covers (L5704-L5707) and protective covering systems (L5962, L5964, and L5966) for the same lower limb prosthesis. 

Oct/25/2016 Össur Reimbursement Workshop at Össur Americas (Orange County, CA)

During this seminar, you will learn the fundamentals and best practices for billing prosthetics including how to successfully handle appeals. You will learn how to minimize reimbursement risk and the time spent on non-clinical activities, read and understand medical coverage policies, develop a strong letter of medical necessity, and work through the appeals process.​

Oct/18/2016 Three Items Needed for a Claim

​Recent audit results from Noridian, Region D DME MAC, indicate three necessary items needed in a file are consistently missing or submitted erroneously. This results in claims denials. 

Oct/11/2016 Knee Instability Documentation

The Knee Orthoses Local Coverage Determination (LCD)​ lists the requirements for medical necessity of specific knee braces. One requirement is documentation of knee instability. 

Oct/07/2016 New MAC Coding Guidance Re. L5930

The DME MACs issued new joint guidance regarding the appropriate use of L5930 in connection with their review of Otto Bock's C-Leg. What did they conclude and what does it mean for you? Read this post to learn more. ​

Oct/04/2016 Off the Shelf and Custom Fit Knee Braces

​Noridian , Region D DME MAC , recently released audit results for Knee Orthoses (KO) . One reason· for denial· is the documentation submitted does not support· the custom· fit· code· billed .  

Sep/28/2016 Billing Miscellaneous Codes

​When the existing HCPCS do not adequately describe a product you have the option to use a miscellaneous code. There are specific requirements to include in your claim when using a miscellaneous code.​

Sep/21/2016 Federal Court Issues Decision on Delays in Medicare Appeal Process

The U.S. District Court ​for the District of Columbia issued an opinion earlier this week regarding several hospitals' request to compel Medicare to hear and resolve its appeals in a timely fashion. What did it say? What does it mean? Read this post to find out.

Sep/13/2016 Are you, or a member of your team, looking to enhance your Orthotic & Prosthetic office skills?

The Orthotic & Prosthetic Office Specialist course will equip you with the highly specialized skills needed in an O&P front office.  This is one of the most comprehensive courses of its kind in the O&P industry, diving deep into Medicare LCD policy, DME MACs, prior authorization, Medicare audits, and more! As a fully online course, it is perfectly suited to fit your busy schedule.

Aug/31/2016 What is PECOS?

The Provider Enrollment, Chain and Ownership System (PECOS) is a database of physicians who are enrolled with Medicare. When a physician prescribes an item, such as an OA Knee brace, the supplier must list the physician’s National Provider Identifier (NPI) number on the claim.

Aug/23/2016 What if a Patient Returns an Item?

​If you provide an item to a patient and it does not fit properly or function appropriately, you are required to accept the return of the item or provide the necessary repairs or replacements. But what about the patient choosing to return the item for reasons that have nothing to do with quality?​

Aug/16/2016 Orthotic Fitter Courses Offered by Össur

​Orthotic Fitter Courses

Aug/09/2016 Clean Claims

A clean claim is one that has no defect or omission, including incomplete documentation, that delays timely payment. Of course, that is the ideal situation.

Aug/02/2016 What Codes to Use When Billing for Repairs

​When an orthosis or prosthesis has to be repaired, and is no longer under warranty, there are specific labor and parts codes you can use.

Jul/26/2016 The Appropriate Way to Give an Upgraded Brace

​Chapter 20, Transmittal 120 of the Medicare Claims Processing Manual lays out the appropriate way to deliver an upgraded device to a beneficiary in conjunction with an Advance Beneficiary Notice.

Jul/19/2016 How Often Can You Give a New Brace?

​Medicare defines a Reasonable Useful Lifetime (RUL) for many items. RUL is the expected minimum lifespan for the item.

Jul/14/2016 Össur Webinar: Understand the Private Payers Coverage Policies for Bracing

Wed, Jul 27, 2016 12:00 PM - 1:00 PM EDT​

Jul/12/2016 OA Knee Bracing: Reimbursement

Our first post provides information about the correct codes and modifiers to use when billing OA Braces. The second post details the specific documentation required to support the various medical coverage policies. Following the guidelines for coding and coverage should logically mean you will be paid for the product, right? In this final post in the three-part series on OA Bracing, we discuss reimbursement challenges.

Jul/05/2016 OA Knee Bracing: Coverage

​In this second post of the three part series on OA bracing, we discuss coverage criteria for Medicare and private payers.​

Jun/29/2016 OMHA's Plan to Reduce the Medicare Appeals Backlog

On the heels of the GAO's report on the Medicare appeals backlog, the Office of Medicare Hearings and Appeals published its own document setting forth its plan to address the issue. Read this post to learn what OMHA is proposing and how it could affect you.​

Jun/28/2016 OA Knee Bracing: Coding

Are you familiar with the coding, coverage and reimbursement issues associated with the Unloader OA knee brace? In this three-part series, we will discuss the basics involved in documenting and submitting Unloader OA knee brace claims to Medicare and private insurers.

Jun/23/2016 Last Chance to Register for Webinar: Understanding Private Payers Coverage Policies for LLP

In this webinar, we will review the major private payers coverage policies for LLP, point out unique requirements to meet the definition of medical necessity, and discuss the product categories covered or considered experimental.

Jun/20/2016 GAO Issues Report on Medicare Appeals Backlog

The GAO recently issued a detailed report on the backlog of Medicare appeals that has steadily grown since 2011. What does the GAO's data show? What are the implications moving forward? Read this post to learn more.​

Jun/13/2016 Össur Reimbursement Webinar: Understanding Private Payers LLP Coverage Policies

In this webinar, we will review the major private payers coverage policies for LLP, point out unique requirements to meet the definition of medical necessity, and discuss the product categories covered or considered experimental.

Jun/07/2016 DWO = Detailed Written Orders

​Recent audit results from the Medicare Administrative Contractors indicate that incorrect DWOs account for a high percentage of claims denials.

Jun/01/2016 Last Chance to Register: How to Appeal a Denied Claim

Join us for a webinar on Jun 02, 2016 at 12:00 PM EDT

May/27/2016 Össur Reimbursement Webinar: How to Appeal a Denied Claim

In this webinar, we will discuss the steps involved in filing an effective appeal of a denied claim. We will discuss identifying the denial reason, appeals process, and the basics of writing an appeal letter. ​

May/24/2016 A Custom Item is Ordered But Not Delivered

​A custom-made item is ordered but not furnished because of (1) the patient’s death, (2) a change in the patient’s condition or (3) the beneficiary cancels the order

May/20/2016 Prior Authorization is Not a Guarantee of Payment

Your patient is in need of a prosthesis or orthosis. You call the private insurance company to obtain prior authorization. The insurance company phone representative does a review of the case and offers a prior authorization number. You also get a message stating that prior authorization is not a guarantee of payment. What does this mean?

May/19/2016 You are invited to an Össur Reimbursement Webinar: How to Appeal a Denied Claim

In this webinar, we will discuss the steps involved in filing an effective appeal of a denied claim. We will discuss identifying the denial reason, appeals process, and the basics of writing an appeal letter.

May/17/2016 Templates and Checklists for Documentation

How many of us take the easy route and use checklists or templates in place of documentation?

May/13/2016 Complaints About Medicare Advantage Plans

Your patient has a Medicare Advantage plan and tells you he can no longer see you because you are not considered in-network with the plan. Or you are contracted with the plan but experiencing delays in obtaining pre-authorization services. What do you do?

May/06/2016 Audit Results of Pneumatic Walking Boots

NHIC, Region A DME MAC, recently released results of an audit on pneumatic walking boots billed with HCPCS 4360. The audit showed an overall claim denial rate of 96.7%.

May/03/2016 Medical Record Documentation Requirements

Can a form or letter signed by the MD be enough documentation for justification or does it need to be in written notes? This is a commonly asked question and the Program Integrity Manual (PIM) provides guidance.

Apr/29/2016 Proof of Delivery Requirements per Stephanie Morgan Greene, Esq.

Stephanie Morgan Greene, Esq, provides detailed information on Proof of Delivery requirements.

Apr/28/2016 MAC Region A Lower Limb Prosthesis Results

NHIC, the DME MAC for Region A, released its quarterly results for lower limb prosthetics. Read this post to learn what you need to know.​

Apr/27/2016 Documentation of Custom Fit Spinal Bracing

​NHIC, Region A DME MAC, recently released results of an audit on spinal orthoses billed with HCPCS L0631 and L0637. The audit showed an overall claim denial rate of 86%.​

Apr/26/2016 Orthotic Fitter Courses

Ö​ssur offers orthotic fitter courses. Read this post to learn more.

Apr/25/2016 Medicare Appeals Process – Level 3: Administrative Law Judge

Your Medicare claim is denied. You submit a reconsideration request and receive yet another denial. What steps do you take to continue the appeal? This is the third in a three-part post on the Medicare appeal process.

Apr/21/2016 Medicare Appeals Process – Level 2: Reconsideration

Your Medicare claim is denied. You submit a redetermination request and receive another denial. What steps do you take to continue the appeal? This is the second in a three-part post on the Medicare appeal process.

 

Apr/19/2016 Medicare Appeals Process – Level 1: Redetermination

You submit a claim to Medicare and receive a denial. What options are available to appeal the denied claim? This is the first of a three-part post on the Medicare appeal processes.

Apr/15/2016 Region D Focusing on Spinal Orthoses

Region D has announced ​a "service specific prepayment probe review" of numerous L codes describing spinal orthoses. Which ones? What does this mean for you? Read this post to learn more.

Apr/12/2016 O&P Separated From DME in the Uniform Glossary

​CMS has finalized a definition of "orthotics and prosthetics" that is distinct from DME in the Uniform Glossary of Coverage and Medical Terms. What does that mean? How does it affect you and your patients? Read this post to learn more.

Apr/11/2016 Audit Results for Ankle Foot Orthosis

Noridian, Medicare Jurisdiction D, announced results of a pre-payment audit for Ankle-Foot Orthosis (AFO) billed with HCPCS codes L1960, L1970 and L4360. 

Apr/07/2016 Last Chance to Register for the Prosthetic Documentation Webinar

​Join us for a webinar on Apr 08, 2016 at 12:00 PM EDT. ​

Apr/05/2016 Coding and Billing of LLP Covers

Lower limb prosthetic covers have specific medical necessity requirements. Your records must document the reason for the cover and the specific uses. This article provides an overview for you.

Mar/31/2016 Össur Reimbursement Webinar: Prosthetic Documentation

​Join us for a webinar on Apr 08, 2016 at 12:00 PM EDT. ​

Mar/29/2016 Spinal Orthoses - Coverage Requirements

Spinal Orthoses claims continue to be a focus of audits. The DME MAC regions continue to audit for general medical necessity documentation.

Mar/24/2016 MAC Region D Prosthetic Foot Review Data

Noridian has published the results of its ongoing review of L5980, L5981 and L5987 claim results. What does the data show? What do you need to know? Read this post to find out.​

Mar/23/2016 Join us for a Prosthetic Documentation Webinar

​Join us for a webinar on Apr 08, 2016 at 12:00 PM EDT

Mar/22/2016 How to Document Replacement Prostheses

Your patient has been on the same prostheses for several years now. The current device is no longer meeting the patient's needs. When and how do you bill for a replacement prostheses?​

Mar/16/2016 Proof of Delivery Clarified

Medicare has issued clarification regarding what constitutes a sufficient description of the item(s) delivered on the required proof of delivery for all claims. What does it say? Read this post to learn more.​

Mar/15/2016 Region D, Noridian Will Also Manage Region A

As announced on December 18, 2015, Noridian Healthcare Solutions (Noridian) was awarded and will begin administering the Jurisdiction A (JA) DME MAC contract. Noridian is still coordinating internal processes and will continue to notify the supplier community of updates and timelines

Mar/08/2016 Don't Miss Our Webinar: Tips and Resources for Orthotic Claims

​Do you and your staff submit claims for orthotics? Wondering if you are using the correct modifiers or codes? Concerned about justifying medical necessity? Join us to learn about resources available to answer your questions. We will share our top bracing reimbursement tips.

Mar/03/2016 Achieving Optimal Prosthetic Outcomes in Physical Therapy

This 2-day offering from Össur Academy will provide education on the treatment & rehabilitation of the lower extremity amputee.

Feb/26/2016 RESCHEDULED: Össur Reimbursement Webinar

Due to unforeseen circumstances, this webinar has been postponed until Wednesday, March 9th.

Feb/09/2016 Back Brace Audit Results

NHIC, DME MAC, Region A, recently posted results of a pre-payment audit for HCPCS codes L0631 and L0637. These LSO codes describe a lumbar- sacral orthosis that has been trimmed, bent, molded, assembled or otherwise customized to fit a specific patient by someone with expertise. The audit covered 1,511 claims from 398 suppliers processed through September 2015 to November 2015. 

Feb/02/2016 Medicare Education and Training Opportunities

​The four regional Medicare Administrative Contractors (MACs) offer webinars and training options for all DMEPOS suppliers. The webinars are presented by the training staff from the MAC, provide an opportunity to learn more about the LCDs and Policy Articles, allow for questions to the MAC staff, and best of all, are free of charge. ​

Jan/27/2016 Last Chance to Register: What you Need to Know about Medicare Prior Authorization

​Össur R&R Webinar: What you Need to Know about Medicare Prior Authorization. Open to all clinical and administrative staff.

Thu, Jan 28, 2016 12:00 PM - 1:00 PM EST​

Jan/26/2016 Can a Physician Bill for Crutches if Located in a Competitive Bidding Area?

According to the Competitive Bidding Program, Medicare beneficiaries may receive crutches, a cane, walkers or a folding wheelchair from a physician and the physician may be paid for the item under specific conditions.

Jan/21/2016 Össur R&R Webinar: Medicare Prior Authorization

What You Need to Know About Medicare Prior-Authorization​​

Jan/19/2016 Can a Nurse Practitioner or Physician’s Assistant Write the Rx?

​If a Nurse Practitioner (NP) or Physician's Assistant (PA) works with a physician, can they sign the Detailed Written Order? The Medicare Program Integrity Manual offers guidance.​

Jan/14/2016 Webinar: What You Need to Know About Medicare Prior Authorization

Confused by the recently-published Medicare rule regarding prior authorization for prosthetics? Don't know which codes are in play? Unsure of whether prior authorization is a good or bad thing for your business?

 

Jan/12/2016 Frequently Asked Questions about Signatures

​The Medicare Administrative Contractors (“MACs”) are cracking down on signatures and certifications.

Jan/08/2016 How to Keep Your Money!

​A confusing but important part of the RAC audit process involves appeal deadlines.

Dec/30/2015 Prior Authorization for Prosthetics: Final Rule Published

Medicare has published its final rule for prior authorization of certain DMEPOS items, including prosthetics. What do you need to know? Read this post to find out.​

Dec/22/2015 Medical Policy Defined

What is a medical policy and why is it important? Read this post to find out.​

Dec/16/2015 Region B Posts Spinal Orthoses Prepayment Review Results

MAC Region B just released the latest results of its prepayment review of claims from July-September 2015. Read this post to find out what the data shows.​

Dec/14/2015 Last Chance to Register for Össur Reimbursement Webinar

What You Need to Know About Reimbursement in 2016 
 
Join us for a webinar on Dec 15, 2015 at 12:00 PM EST. 

Dec/11/2015 Össur Reimbursement Webinar

​Don't Miss Out: Join Us for a Webinar on Reimbursement Trends for 2016

Dec/09/2015 Use the Correct Modifier

Modifier mistakes, improperly used or omitted, are the number 1 reason for front end claims rejections. Are you using all the correct modifiers for the HCPCS codes you bill?

Dec/07/2015 What You Need to Know About Reimbursement in 2016

Join us for an insightful discussion on trends and predictions for the O&P industry in 2016. Learn how this will impact your practice and what you can do to be prepared. 

Dec/04/2015 Addendums to Physician Notes

We have received several questions about addendums to physician's notes. For a detailed explanation of how to best use addendums we go to Stephanie Greene from The Audit Team.

Dec/03/2015 Prosthetic Pre-Payment Claim Review Results from Region A

​DME MAC Region A recently published its quarterly results for the ongoing prepayment claim review of K3 prosthetic claims. Read this post for the details.

Dec/02/2015 Region A's Prepayment Reviews for Orthoses

The DME MAC for Region A has published the results of prepayment reviews for pneumatic walking boots and AFO's. Read this post to learn more about what NHIC found.​

Dec/01/2015 What About Returns of DMEPOS Items?

​If you provide an item to a patient and it does not fit properly or function appropriately, you are required to accept the return of the item or provide the necessary repairs or replacements. But what about the patient choosing to return the item for reasons that have nothing to do with quality? ​

Nov/20/2015 Recovery Auditors Start Auditing, Again

​After an almost one year long hiatus, the Recovery Auditors (RA) have been given the green light to start auditing DMEPOS claims again. CMS approved the audits to begin effective November 15, 2015. ​

Nov/17/2015 The Medicare Supplier Manual

​In addition to LCDs, Policy Articles, and other articles published by the MACs, the supplier manual is available to assist suppliers with information on supplier enrollment, claims submission, ABNs, documentation, and coding.​

Nov/12/2015 Knee Bracing Before Total Joint Replacement Surgery

​Did you know Medicare and the major insurance providers are requiring conservative treatment before authorizing total joint replacement surgery? ​

Nov/06/2015 Clarification

Additional information regarding yesterday's post re. PDAC​

Nov/05/2015 Does a Product Have to be Listed on PDAC?

We continue to receive questions about the PDAC's role i​n verifying product coding. Here's a primer on what you need to know about this Medicare contractor.

Nov/05/2015 Webinar: The Prosthetic Draft LCD: Analyzing Medicare's Decision and Looking at What it Means Going Forward

​Join us for this webinar and discussion.

Nov/02/2015 White House Announces CMS Striking Down Draft LCD!

In response to the "We the People" petition created by the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), the White House announced today that the DME MACs will not finalize the draft LCD for lower limb prostheses. What does this mean? Read this post to find out more.​

Oct/30/2015 Claims Denied for Inaccurate Delivery Tickets

The Proof of Delivery requires items to be identified by make, model number and a narrative description of the product. 

Oct/27/2015 Medicare Advantage Open Enrollment Period

Every year the open enrollment period for Medicare Part C, known as Medicare Advantage, is October 15 – December 7th. What do you and your patients need to know?

Oct/23/2015 ICD 10, More Information

By now we are becoming familiar with the new ICD 10 codes. We know the codes address the issue of specificity. O&P providers are required to work closely with the prescribing physician on assignment of the correct code. But what happens when the physician's chosen code is not specific enough? What about the seventh character, which designates initial or subsequent encounter? Read on for answers and links to resources.

Oct/16/2015 S.O.A.P. Notes

A standardized format for clinical notes is one way to prepare your practice for claims reviews or audits. The most common form of clinical notes is the SOAP note.

Oct/13/2015 Common Claims Denials

A clean claim is one that has no defect or omission, including incomplete documentation, that delays timely payment. Of course, that is the ideal situation. In reality, claims are delayed or even denied for simple errors.

Oct/09/2015 Upcoming ICD-10 Webinars

​ICD-10 webinars are open to all DMEPOS suppliers.

Oct/06/2015 ICD-10 is Here

On October 1, 2015 the ICD codes replaced the ICD-9 version to a new and expanded version, ICD-10

Sep/30/2015 Understanding Denials: Private Payer Claims

One common reason for claim denial is “lack of medical necessity.” Without understanding the details behind this generic denial reason, it is almost impossible to prepare a logical appeal. What resources are available to provide more information about the specific denial?

Sep/25/2015 Understanding Denials: Medicare Claims

One common reason for claim denial is “lack of medical necessity.” Without understanding the details behind this generic denial reason, it is almost impossible to prepare a logical appeal. What resources are available to provide more information about the specific denial? 

Sep/22/2015 Reimbursement Questions

​Join us for this webinar to get answers to your most challenging reimbursement questions. 

Sep/18/2015 International Prosthetic Symposium

Össur Academy is sponsoring an International Prosthetic Symposium November 19-21, 2015 with 8.25 CEUs available.

Sep/15/2015 Replacing a Socket

​How often can you bill for a new socket? What documentation is required to justify a socket replacement? These are common questions and the answers are found in the Local Coverage Decisions (LCDs.)

Sep/10/2015 Limiting the Scope of Audits

Medicare recently provided clarification to the MACs and QICs regarding the type of issues they can identify for denial when reviewing a claim. The new policy impacts claims with dates of service August 1, 2015 and after.

Sep/07/2015 Prosthetic Outcomes for Physical Therapists

​Physical Therapists are a great addition to the prosthetic team and may help provide corroborating documentation. Do you have PT colleagues interested in learning more about prosthetic outcomes? Please share information about this exciting, hands-on training event with CEUs included.​

Sep/02/2015 Countdown to ICD-10

On October 1, 2015 the ICD codes will replace the current version (ICD-9) to a new and expanded version, ICD-10. All healthcare providers, including DMEPOS suppliers, submitting claims are required to use ICD-10 after that date.

Aug/27/2015 Ground Zero for #NotALuxury: Action in Baltimore and D.C.

​​The DME MACs held an important public meeting yesterday, followed by a rally and a meeting involving high-ranking CMS/HHS officials. What do you need to know about what happened? Read this post.​

Aug/21/2015 Draft LCD for Lower Limb Prostheses: Open Comment Meeting

​The process of proposing changes to the LCD requires a public meeting, where interested parties may provide input on the changes. The DME MACs are holding a public meeting regarding the Lower Limb Prostheses LCD on August 26, 2015.​

Aug/20/2015 Össur R&R to Participate in NAAOP Webinar re. Draft LCD

Össur R&R to Participate in NAAOP Webinar re. Draft LCD​

Aug/18/2015 Signatures and Certifications

​The Medicare Administrative Contractors (“MACs”) are cracking down on signatures and certifications. 

Aug/13/2015 Rescind the Draft LCD

Go to www.saveprosthetics.org and sign the petition.

Aug/10/2015 Help Spread the Word: Rescind the Medicare Proposed LCD for Lower Limb Prostheses

​The momentum is growing and we are getting our message out. The Medicare proposed LCD for Lower Limb Prostheses is detrimental to those living with limb loss and to our industry as a whole.​

Aug/07/2015 Listen Again: Draft LCD for Lower Limb Prostheses

​The DME MACs released a new draft LCD for lower limb prostheses that could replace the current one. The ramifications are potentially far reaching. It is not an exaggeration to say that this might be the most significant change to prosthetic billing and coverage requirements since the creation of the L codes if the draft were implemented in its current form.

Aug/06/2015 WE PETITION THE OBAMA ADMINISTRATION TO: Rescind the Medicare proposal restricting access to prosthetic limbs

​Please sign and share the online petition

Aug/03/2015 Items Not Covered by Medicare

​If a particular device is excluded from Medicare coverage, it is acceptable to sell it as a cash item and accept payment from the beneficiary at time of delivery

Jul/31/2015 Register Now: Ossur R&R Webinar with the latest information on the Draft LCD for LLP

​Join us for a webinar on Aug 05, 2015 at 12:00 PM EDT.

Jul/29/2015 Ossur R&R Webinar: Draft LCD for Lower Limb Prosthesis

Join us on this webinar to learn more about the proposed changes and how you can get provide input on the changes. 

Jul/27/2015 Common Denials for Lower Limb Prostheses Claims

Region D, Noridian Medicare, recently published an article with common CERT claims denial reasons for Lower Limb Prostheses.

Jul/24/2015 Last Chance to Register: How to Appeal Experimental & Investigational Denials

Attend this practical, informative webinar, which will walk you through the key steps you should take to when a claim has been denied as "experimental and investigational." 

Jul/21/2015 Draft LCD for Lower Limb Prostheses: How to Comment

​Last week the DME MACs released a new draft LCD for lower limb prostheses that could replace the current one. The ramifications are potentially far reaching. It is not an exaggeration to say that this might be the most significant change to prosthetic billing and coverage requirements since the creation of the L codes if the draft were implemented in its current form.

Jul/20/2015 You are invited to a free webinar: How to Appeal Experimental & Investigational Denials

​Attend this practical, informative webinar, which will walk you through the key steps you should take to when a claim has been denied as "experimental and investigational." Learn the proactive strategies to implement, even prior to delivery of the product, to increase your chances of obtaining positive coverage

Jul/17/2015 Huge Changes for Prosthetics? The New Draft LCD

The DME MACs just released a new draft of the Lower Limb Prostheses LCD and related Policy Article. What do you need to know? Read this post to find out!

Jul/14/2015 Prosthesis Replacement

​Your patient has been on the same prostheses for several years now. The current device is no longer meeting the patient's needs. When and how do you bill for a replacement prostheses?

Jul/01/2015 Three Months: Countdown to ICD-10

​ On October 1, 2015 the ICD codes will replace the current version (ICD-9) with a new and expanded version, ICD-10. All healthcare providers, including DMEPOS suppliers, submitting claims are required to use ICD-10 after that date.

Jun/23/2015 What to do when you have concerns about the MAC audit process?

​One complaint we consistently hear from providers is about audits. Some have concerns about the number of audits while others are concerned about the overall audit process. CMS has a resource to listen and provide assistance, as appropriate.​

Jun/15/2015 What does "PDAC Approved" really mean?

​What does "PDAC Approved" really mean?

Jun/09/2015 Replacement Orthoses

​You provided an Unloader One to a patient two years ago. The patient dutifully wears the brace every day and is experiencing significantly less pain. Today the patient returns to your office with a sad story of losing the brace in a flood. Can you bill Medicare for a new L1843 even though the reasonable lifetime of three years has not been met? ​

Jun/04/2015 Same or Similar, Part Two

​You have a prescription to provide a brace to a Medicare beneficiary. You check the appropriate DME MAC website to determine if the beneficiary has received a same or similar device in the past. The online record indicates the patient received an identical item two years ago. What do you do now?​

Jun/01/2015 Same or Similar

​According to Medicare, braces have a Reasonable Useful Lifetime (RUL) This means that if another brace, which is the same or similar to the one originally dispensed, is provided to the beneficiary within the RUL it will be denied. How do you find out if the beneficiary has received a same or similar device in the past?​

May/26/2015 Last Chance to Register for Off the Shelf vs Custom Fit code clarification webinar

​Confused about the Off the Shelf versus Custom-Fit codes? 

May/21/2015 New Pre-Payment Probes for L1940 and L4360

NHIC, Region A, Medicare Administrative Contractor has announced new prepayment probes for AFOs billed with L1940 and Pneumatic Walkers billed with L4360.

May/19/2015 Medicare Coverage Basics

Medicare has revised its brochure detailing what it does not cover.​ What do you need to know about it? Are there any hidden pearls of wisdom in it? (Answer: yes.) Read this post to find out more.

May/18/2015 Confused about OTS vs Custom-Fit Codes?

Participate in a  free webinar to review the creation of the Off the Shelf versus Custom-Fit codes, the requirements to bill a Custom-Fit product, and a discussion of the current claim reviews in place.

May/14/2015 Medically Necessary Criteria for Spinal Bracing

In order for an item to be considered for coverage by Medicare, it must be “reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member…” The Local Coverage Decisions (LCDs) give detailed information about medical necessity requirements for various types of braces.

May/08/2015 Additional Information on Denials

Your claim is reviewed by the regional DMEMAC and you need additional information about the specific reasons for denial. Read on to learn what tools are available to you.

May/06/2015 Orthosis LCD Updates

The DME MACs have revised the LCD's for AFO's/KAFO's, knee orthoses and spinal orthoses. What are the changes? How do they affect you? Read this post to find out more.​

May/05/2015 New Prosthetic Prepayment Claim Review Results for MAC A

MAC Region A published the latest set of results arising out of its review of K3 prosthetic claims. What does the data reveal and how does it affect you? Read on for more info.​

May/04/2015 Region A Posts New Spinal Orthoses Data

​MAC Region A published the latest results from its prepayment claim review of spinal orthosis claims. Read this post for more information.

May/01/2015 The OTS/Custom-Fit Difference

The DME MACs have published a new joint publication intended to clarify the OTS/custom-fit distinction. Since this issue continues to confuse people, we revisit the topic in this post.​

Apr/21/2015 Last Chance to Register for Free Appeals Webinar

​Join us for "Steps to Succesful Appeals" a free webinar sponsored by Ossur. 

Apr/14/2015 Register now for a free webinar: "Steps to Succesful Appeals"

You are invited to a free webinar. "Steps to Succesful Appeals"​

Mar/31/2015 New and Improved Reimbursement Resources

​As a subscriber to Ossur R&R, you are able to access valuable reimbursement resources. We recently added new checklists and guides specific to OA & Injury Solutions products.​

Mar/17/2015 Supreme Court Expands Agencies' Authority

Why should you care about a Supreme Court decision involving the Department of Labor? Read this post to find out.​

Mar/10/2015 What's a referral?

The United States Court of Appeals for the 7th Circuit issued an opinion discussing what a referral is in the context of the Anti-Kickback law? What did they say? Why should this matter to you? Read this post to learn more.

Mar/04/2015 Make and Model Numbers Required on Proof of Delivery

​ The DME MACs recently released a joint publication with information about Proof of Delivery (POD) details and requirements. The article clarifies the purpose of the POD and the format of specific items.

Feb/26/2015 ​A Resource to Assist with your Audit Concerns

​One complaint we consistently hear from providers is about audits. Some have concerns about the number of audits while others are concerned about the overall audit process. CMS has a resource to listen and provide assistance, as appropriate.

Feb/23/2015 OIG Issues New Report on O&P Facility

​The Office of the Inspector General released its 6th report analyzing an individual O&P facility. What were the findings? What do they mean? Read this post for more information.

Feb/19/2015 ​Don’t agree with a Recovery Auditor Determination?

​You receive an audit on one of your claims. Because you are an avid R&R reader, you understand all the required documentation to submit for review

Feb/16/2015 Proof of Delivery Clarification

​The DME MACs recently released a joint publication with information about Proof of Delivery (POD) details and requirements. The article clarifies the purpose of the POD and the format of specific items.

Dec/05/2014 Back Braces: Audit Results

MAC Region D (Noridian) released audit results from its widespread pre-payment claim review for L0631 and L0637.

Feb/02/2015 New Prosthetic Prepayment Results from Region A

Region A released the latest data from its prepayment review of K3 prosthetic​ claims. What does it show? Read this post for all the relevant info.

Jan/30/2015 60% of What?

When replacing a prosthetic component, Medicare policy states that one of three possible factors justifying replacement is when the cost of the repair will exceed 60% of the cost of replacement. But what's  the metric for "replacement"? The manufacturer's invoice? The Medicare allowable? Read this post to find out the details.     ​

Jan/29/2015 Products Requiring PDAC Coding Verification

​We are continually asked if a product has a “PDAC letter.”What does this really mean and which products actually require coding verification letters?

Jan/26/2015 Spinal Orthoses Audit Results

​National Government Services, Jurisdiction B, released results of a prepayment audit on Spinal Orthoses, HCPCS L0450-L0640. The 2014 third quarter audit resulted in a 96.2% claim error rate.

Jan/20/2015 Last chance to register for a free webinar on Audits: Myths and Facts

​Join us on this informative webinar with guest speaker, Stephanie Greene, Esq, CPC, from The Audit Team. Stephanie will present the latest information about audits, the myths and facts.

Jan/15/2015 New K3 Foot Results from Region D

Noridian has released its most recent prepayment claim review results for L5980 foot claims. What does the data show? Read this post to find out.​

Jan/08/2015 Knee Orthoses Audit Results

​Noridian, Region D DMEMAC, just released the results of prepayment audits on HCPCS codes L1832, L1833, and L1843.

Jan/06/2015 The Mega-RAC is Here

CMS has announced the award of a new RAC contract. What do you need to know? Read this post to find out the latest.​

Dec/11/2014 Ankle Brace Documentation Requirements

MAC Region D (Nordian) recently announced the results of a pre-payment audit for HCPCS codes L1960, L1970 and L4360 for claims submitted between June 2014 - September 2014

Dec/09/2014 Last chance to register: The 5 Things Affecting Orthotic and Prosthetic Reimbursement in 2015

​Free Webinar

​Join us for an insightful discussion on trends and predictions for the O&P industry in 2015. Learn how this will impact your practice and what you can do to be prepared.

​Open to all clinical and administrative staff.

Nov/25/2014 Proof of Delivery Requirements

​Recently, several questions have come to us about what exact details are required on a delivery ticket, also known as a Proof of Delivery (POD.)

Nov/20/2014 Much Room For Improvement in Region D

MAC Region D released prepayment claim review results for two prosthetic foot codes. What did they show? Click here to find out.​

Nov/18/2014 Three Things ....

Recent Medicare and OIG news summarized. Review this post to get the details!​

Nov/10/2014 Audit Results for Back Braces

​NHIC Corp, Region A DME MAC, released audit results from its widespread pre-payment review of claims for L0631 and L0637. The results, which covered the time frame from January 13 - April 13, 2014, show an overall charge denial rate of 83.3% for spinal orthoses claims.

Nov/04/2014 Clarification That Confuses

​Medicare published its final rule addressing the definition of "minimal self-adjustment" on Halloween. What does it say and what does it mean for you? This post tries to cut through the confusion.

Oct/27/2014 Region A Hits All Time Low ... And That's Good!

Region A has published the latest quarterly prepayment claim review results​ for K3 claims. Were they good? What do they mean? Read this post for the details. 

Oct/24/2014 More on Medicare Advantage Plans

​Last week’s post on Medicare Advantage Open- Enrollment (Medicare Advantage Open Enrollment) prompted thoughtful questions from several readers.

Oct/22/2014 K3 Feet in Region D: The Trend Continues

MAC Region D has focused its prepayment claim review activity in prosthetics almost exclusively on K3 feet. What does the latest data show? More of the same. Read this post for our detailed analysis.​

Oct/21/2014 Trick Question: What's the RUL for Prosthetic Devices?

We commonly receive questions about the reasonable useful life for prostheses. Just as often, people tell us that the RUL is "x" years. Let's eliminate the confusion once and for all, shall we?​

Oct/03/2014 New Recovery Auditors Annual Report Released

Every year Medicare issues a report summarizing the activity of the controversial Recovery Auditors. The FY 2013 data is in - what does it tell us? Read this post to find out more.

Sep/30/2014 New K codes…what you need to know to be oK.

Effective October 1, 2014 Medicare has created two new codes describing off-the- shelf knee orthoses: K0901 (single upright) and K0902 (double upright).

Sep/11/2014 Last chance to register for the free webinar on "The Basics of Billing Braces" September 16, 2014

​Join us for a free educational webinar on the coding, coverage, reimbursement and billing details related to orthotics.

Aug/26/2014 The Basics of Billing Braces
Aug/21/2014 Audit Results for Off the Shelf, Custom Fabricated and Custom Fit Braces

​Region D Noridian recently released the results of prepayment reviews for specific Orthoses codes.

Aug/14/2014 Small Sample, Bad Results

MAC Region D has published the results of its L5987 review from March through June 2014. It ain't pretty. Click here to learn more.​

Aug/08/2014 Ossur Women's Leadership Initiative

Ossur is creating a leadership development group for female O&P practitioners. For more information, read this post. 

Aug/07/2014 A Double Dose

A Federal Court dismisses AOPA's complaint against Medicare and the RACs are back. What happened? What does this mean for you? Read on.

 

Aug/06/2014 Knee Braces, Back Braces and Region D

​Noridian, Region D contractor for DMEPOS, announced it would begin pre-payment probe audits on Spinal Orthoses (HCPCS L0648 and L0650) and Knee Orthoses (HCPCS L1832, L1833, and L1843.)

Jul/31/2014 Number 10 From Region A

​MAC Region A has published its 10th report since 2011 summarizing the results of its ongoing prepayment claim review for K3 prosthetic claims. What did the latest data reveal? Read this post to find out!

Jul/22/2014 The Right Way to Give a Custom Brace

Payors only reimburse “medically necessary” care and devices. They don’t cover “quality of life” improvements. To use a vehicular analogy that insurers seem to universally embrace, they’ll provide you basic transportation (Sentra) but if you want a luxury ride (Cadillac), you‘ll have to pay the difference.

So how do you manage the patient who wants the Cadillac?

 

Jul/15/2014 1,2,3 for Orthoses Claims Billing

​Do you know what documents you must have in your files prior to submitting a claim?

Jul/10/2014 Region D Targeting K3 Feet

MAC Region D published the latest in a series of prepayment claim review reports last week. What did it show? What are the overall trends? Read this post to learn more.​

Jul/07/2014 OA Bracing: Reimbursement

This is the third in a three part series on OA Bracing.

Jun/23/2014 OA Bracing: Coverage

​In this second post of the three part series on OA Bracing, we discuss coverage criteria for Medicare and private payers.

Jun/12/2014 OA Bracing: Coding

​Providing OA Braces to patients is an easy and viable option that provides immediate results.

 
Are you familiar with the coding, coverage and reimbursement issues associated with the Unloader OA Knee Brace?

 

Jun/06/2014 Medicare and Prosthetic Prior Authorization: How Would It Work?

Medicare has published a draft rule that would require prior authorization for prosthetic devices. While lots of people are screaming "No!" or "Yes!" in response, what does the draft rule actually SAY? Read on to understand the details. ​

Jun/05/2014 PECOS and DMEPOS

​The Provider Enrollment, Chain and Ownership System (PECOS) is a database of physicians who are enrolled with Medicare. When a physician prescribes an item, such as an OA Knee brace, the supplier must list the physician’s National Provider Identifier (NPI) number on the claim.

May/28/2014 Clean Up Your Claims

​A clean claim is one that has no defect or omission, including incomplete documentation, which delays timely payment.

May/21/2014 L0631 and L0637 Audit Results

​Region D recently announced the results of an audit on Spinal Orthoses claims.

May/16/2014 Custom AFOs Audit Results

​Region D recently announced the results of an ongoing audit for AFOs.

May/14/2014 Walking to Nowhere in Region D

New prepayment claim review results from MAC Region D for one of the K3 foot codes. What were they? What do they tell us? Read this post to learn more. ​

May/08/2014 The Path to a Successful Claim

What's the best way to get your claims approved? How can you minimize your financial risks? We have a solution for you - read on to find out more.​

Apr/25/2014 MAC Region A Q1 Prosthetic Review Results (With Charts!)

MAC Region A has released the results of prepayment claim reviews of K3 prosthetic claims for the first quarter. Any new trends? What do you need to know? Read on to find out.​ Bonus feature: we have CHARTS! 

Apr/10/2014 Code Confusion & OTS Orthotics: What Can You Do?

The new orthotic "exploded" codes have created confusion, especially when it comes to items for which the PDAC has previously conducted coding verifications. What should you do? Read this post to find out.

Apr/07/2014 Wondering how to document replacement prostheses?

Join us for a free and informational webinar on April 8
presented by The Audit Team.
 

 

Apr/03/2014 The ABC's of ABN's

The Advance Beneficiary Notice of Noncoverage regularly provokes confusion and questions from our readers. Here's the quick and easy guide to understanding ABN's.​

Apr/01/2014 You are invited to participate in a free webinar focusing on replacment devices

​Prosthetic Claims Documentation Requirements: Replacement Prostheses. Webinar on April 8, 2014

Mar/28/2014 Orthoses Defined (Again. Hopefully for the Last Time.)

​After publishing and then rescinding guidance regarding key terms for orthotic L codes, the MACs have now released updated guidance. What does it say? How does it affect you? Read this post to find out!

Mar/21/2014 New Prosthetic LCD Update

All 4 DME MACs have published updated Local Coverage Determinations for lower limb prostheses. There's 1 big change you need to know about. Read more to find out what it is.​

Mar/18/2014 Ossur Claims Quality Assurance Review Program

​Do you want the security of knowing that your claim contains all Medicare- required documentation before you file it?

Mar/12/2014 Region D Clamps Down on K3 Feet

MAC Region D has published the results of its review of L5987 claims. What was the claim error rate? What will Region D now do? Read this post for the details.​

Mar/11/2014 Last Chance to Register: Lessons Learned: Audits, Appeals and How They Impact Bracing

​Auditors are increasingly focusing on bracing products and denying payment on claims. Join us for this informational webinar to learn about the current audit situation, what you can do to increase your chances of a successful audit, and how to appeal your bracing claim denials. The webinar is offered free to Ossur customers.

Mar/08/2014 Orthotics Undefined

More guidance from the MACs about the definitions for orthotic codes. Can you say, "180"? Read this post for more.​

Mar/06/2014 Lessons Learned: Audits, Appeals and How They Impact Bracing

​Auditors are increasingly focusing on bracing products and denying payment on claims. Join us for this informational webinar to learn about the current audit situation, what you can do to increase your chances of a successful audit, and how to appeal your bracing claim denials. The webinar is offered free to Ossur customers.

Mar/03/2014 Proof of Delivery 1-2-3

Are you complying with all the requirements for a valid proof of delivery? Any oversight may result in a claim denial.

Feb/28/2014 Orthotics Redefined

​Medicare Administrative Contractors issue clarification on codes.

Feb/20/2014 A Temporary Reprieve

CMS announced changes to the RAC program. How will this effect your business? What are the changes? Read more to find out.​

Feb/19/2014 Same and Similar

The January 29, 2014 post “Life Expectancy” prompted several questions about how to determine if a patient has received the same or similar device in the past. There are steps to follow increase chances of a positive payment.

Feb/13/2014 The OIG's Road Forward

OIG has released its 2014 Work Plan. What's in it? How will it affect you? Read this post for all the details.​

Feb/11/2014 New Audit Issue…Watch Your Back

The Region A Recovery Auditor has posted a new issue for review:  “Spinal Orthoses: Thoracic Lumbar Sacral Orthoses and Lumbar Sacral Orthoses.”

Feb/10/2014 Back by Popular Demand

Join us for this encore presentation of a webinar on the documentation needed to appropriately support prosthetic claims in case of an audit. Stephanie Greene from The Audit Team will present an actual case study complete with examples of notes, forms and reports.

Sponsored by Ossur.

The previously recorded webinar will be presented.

Feb/05/2014 Four for Backs

​Jurisdiction D, Noridian, has announced the latest results for its Spinal Orthoses prepayment review (codes L0631 and L0637).

Feb/04/2014 New Year: New Resources

Always looking to improve, Ossur R&R offers you 5 new and improved Reimbursement Guides. Check out this post to learn what they are and why they're better! ​

Jan/30/2014 Region D's Bad AFO/KAFO Scores

MAC Region D just released new prepayment review results for AFO/KAFO claims. The data isn't pretty. What do you need to know and what does it mean?​

Jan/24/2014 Oh-fer

MAC Region D has published the results of its prepayment review of L5981 claims. Very small sample. Very poor results. Read the post to find out more. ​

Jan/23/2014 New Year, Same Issues in Region A

MAC Region A just published its latest prepayment review results for K3 prosthetic claims. What do you need to know? We've got the answers in this post.​

Jan/22/2014 Webinar Invitation: Join us for "Prosthetic Claims Documentation Requirements: A Case Study"

Final day to register.
 
​Join us for this informational webinar on the documentation needed to appropriately support prosthetic claims in case of an audit. Stephanie Greene from The Audit Team will present an actual case study complete with examples of notes, forms and reports.

Jan/20/2014 More on the New Codes

​As we stated on December 9, 2013 in the R&R Bulletin, Medicare has modified the language of 23 already-existing L-codes to add the words, "prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise" to the end of the description.

Jan/17/2014 A PECOS Resource

Since our ​December 12th post on PECOS, we have learned of a tool that you may find useful. Read more to understand what it is, how it works, and where you can find it.

Jan/09/2014 Cleaning up documentation s-o-a-p

​A standardized format for clinical notes is one way to prepare your practice for claims reviews or audits.

Jan/07/2014 More Ways to Get Paid in 2014

​With the New Year comes new deductibles and benefit plans.

Dec/19/2013 2014 Fee Schedule Update - Things Come Into Focus

Medicare has released the 2014 fee schedule. In this post, we break down the most important things you need to know.​

Dec/12/2013 New "Dear Physician" Letter: PECOS is Coming!

The Medicare Administrative Contractors have issued a new "Dear Physician" letter. What does it say? What does it mean for you? Read this post to find out.​

Dec/09/2013 2014's New and Modified Codes - What You Need to Know

Medicare has released the 2014 HCPCS Code Set. Big changes in orthotics are looming, and there's news on the prosthetic side as well. What do you need to know? Read on to find out. ​

Oct/31/2012 ‘Tis the Season….for enrollment in Medicare Advantage plans
Nov/19/2013 ​Bowling for Denials

At least one Recovery Auditor has adopted a novel approach to K level determinations. What is it? How do you fight it? Read this post for the necessary information.​

Nov/18/2013 Ask the Össur Orthotics Reimbursement Expert

​ Free webinar scheduled for December 6, 2013 at 1pm EST.

Nov/15/2013 Maintain Your Standards

Medicare ha​s a lengthy list of Supplier Standards you need to comply with. Do you? In this post we give you a summary of 6 of the often-overlooked/misunderstood standards.

Nov/08/2013 A Solution for Your Claims Problems

Are your Medicare claims getting denied during prepayment review? Are you losing money to Recovery Auditor clawbacks? Are you not sure if your claims satisfy payer requirements? We have an answer for you.​

Nov/07/2013 Four Reports, One Interpretation

The OIG just released the 4th report since July about MACs' processing of lower limb prosthetic claims. What should you take away from this systematic dive into the world of O&P by the OIG? Read this post for our intrepretation. ​

Nov/06/2013 A New Audit Issue

​Region C has published a new audit issue that, while focused on hospital and physician claims, may have a significant impact on orthotic claims

Oct/28/2013 When Scoring Less Than 50% is a Good Thing

New results from MAC Region A on its widespread prepayment review of lower limb prosthetic claims. There's some good news and some bad news. To learn about both, read this post!​

Oct/25/2013 Proof of Delivery

​Results of a recent audit by Region D indicate that a significant percentage of Orthoses claims had incorrect Proof of Delivery documentation. The MAC denied claims based upon the missing information.

Oct/23/2013 A Painful Probe in Region D

MAC Region D announces new results from a prosthetic foot widespread prepayment probe review. Here's the info and what it means for you.​

Oct/22/2013 Coverage Requirements for Spinal Orthoses

​MAC Region D has announced the results of an audit of Spinal Orthoses with HCPCS codes L0637 and L0631.

Oct/21/2013 Done.

The updated and corrected POWER KNEE Reimbursement Guide is now available for download.​

Oct/18/2013 Update to our Update! Important!

We're making edits to the recently-updated POWER KNEE Reimbursement Guide that we released earlier this week. Learn why.

Oct/17/2013 All About Audits

​Today is the last chance to sign up for the "Ask the Audit Expert" webinar scheduled for tomorrow, October 18, 2013 at 1pm EST.

Oct/15/2013 High Horsepower Reimbursement Support

Ossur has updated its Reimbursement Guide for POWER KNEE. Read more to understand what's new.​

Oct/14/2013 Reimbursement Support in a Vacuum

​Ossur's Reimbursement guide for its Unity sleeveless vacuum system is now available for download.

Oct/10/2013 Modifiers

Specific products and product categories require the use of one or more modifiers in order to make the claim eligible for payment.

Oct/08/2013 Guilt By Association

Medicare recently published its Fee-for-Service 2012 Improper Payments Report. What are the implications for O&P? Read on to get our take.

Oct/02/2013 A New R&R Resource For You!

Ossur unveils its latest downloadable tool to help you address reimbursement challenges.​

Oct/01/2013 One, Two….

Prosthetic claims that include a second liner are being denied.

Sep/24/2013 They're Looking at Your Feet!

MAC Region D announces a new prepayment review of certain K3 feet.​

Sep/11/2013 A New OIG Report ... On MAC Region D

OIG has issued a new report on MAC Region D. While the report has a few interesting facts, equally relevant is Region D's response back to the OIG. Here's what you need to know.​

Sep/05/2013 A New OIG Report ... On RACs

OIG just published a new report on the RACs. What are the key findings? What does it mean for O&P?​

Sep/04/2013 Alphabet Soup: HCPCS & PDAC

What's the difference between different entities involved in L-codes? Here's the quick and easy explanation.​

Sep/03/2013 L5930: What You Need to Know

We continue to get regular questions about the appropriate use of L5930 (“high activity knee control frame”) from prosthetists around the United States. While Medicare’s guidance about this code qualifies as “old news,” we thought a quick and clear description of the applicable requirements would help.

Aug/28/2013 Are you bracing yourself?

All four DME MACs have announced a revision of the LCD for knee bracing. The new version includes coverage criteria for ruptured tendons.

Aug/27/2013 Nobody Likes Rejection

​According to MAC Region A, the top reasons for claims rejection involve modifiers. Invalid or missing modifiers may cause claim rejection.

Aug/22/2013 Back to Basics: The Prosthetic LCD (Part 4)

The final installment in our series reviewing the key elements of Medicare's Lower Limb Prostheses LCD.​

Aug/18/2013 OIG Finds Fault with Region A

A new OIG Report on lower limb prosthetic claims may portend continued scrutiny of these claims moving forward.​

Aug/16/2013 Back to Basics: The Prosthetic LCD (Part 3)

​In Part 3 of this series, we review the LCD's treatment of "general" (Medicare's term, not ours), feet, knees, ankles, hips and sockets.

Aug/15/2013 Back to Basics: The Prosthetic LCD (Part 2)

​In Part 2 of this series, we look at the LCD's discussion of functional levels.

Aug/14/2013 Back to Basics: The Prosthetic LCD (Part 1)

In Part 1 of this series, we explain Section 1 of the Lower Limb Prostheses LCD, which addresses coverage indications, limitations and medical necessity.

Aug/06/2013 R-E-S-P-O-N-D
Aug/02/2013 When 99% is not good….
Jul/31/2013 Back starts with B
Jul/25/2013 Some RAC Slack?

Anecdotal evidence that Medicare has instructed the RACs to shift their auditing focus.​

Jul/21/2013 New OIG Report re. MAC Region C Claims

What does OIG think of Region C?

Jul/16/2013 Claim Adjustment Reason Code 223 Explained
Jun/17/2013 MAC Region A Results: Remember to Touch all the Bases!

MAC Region A's new prepayment claim review results for early 2013 reveal that prosthetic suppliers continue to struggle with basic documentation requirements.​

Jun/14/2013 Why CMS Fraud Prevention Efforts are Here to Stay

​New data from HSS showing increased success in combating fraud will likely increase scrutiny of claims in the future.

Jun/13/2013 The Right Way to Give Your Patient More

Payors only reimburse “medically necessary” care and devices. They don’t cover “quality of life” improvements. To use a vehicular analogy that insurers seem to universally embrace, they’ll provide you basic transportation (Sentra) but if you want a luxury ride (Cadillac), you‘ll have to pay the difference. So how do you manage the patient who wants the Cadillac?

Jun/06/2013 A Takes a Step Forward

​Performant Recovery, the Recovery Auditor for Region A, recently posted a new audit issue, listing certain HCPCS codes that cannot be billed with pre-fabricated AFOs and KAFOs.

Jun/03/2013 Getting Better in B?

​MAC Region B error rate falls by more than half. But close to half of all claims still getting denied. Why?

May/28/2013 The Heat is BACK

​MAC Region D releases information about audit of spinal orthoses claims. They denied the majority of claims for not meeting medical necessity requirements. What does this mean for your practice? 

May/24/2013 The Template Meeting You Should Attend!

​Why you need to attend Medicare's Open Door Meeting Tuesday, May 28, 2013.

May/22/2013 The Solution to Medicare-Compliant Claims

​Ossur has partnered with HMG/The Audit Team, a company whose principals have more than three decades of experience in the world of O&P and DME. With a staff of experienced coding, clinical, and legal personnel, The Audit Team now offers its Quality Assurance Review package for Ossur's Bionic products. ​

May/21/2013 How Gifts Can End Your Career

​As government scrutiny of health care generally, and O&P specifically, explodes, you need to carefully consider the "freebies" offered to you and the risks they pose. As the government's recent case against Orthofix proves, taking gifts can put your business at risk today and you in jail tomorrow.​

May/21/2013 A New Template for O&P

​The Centers for Medicare and Medicaid Services have posted a draft Lower Limb Prosthesis Electronic Clinical Template on its website. The four-page document "describes the data elements that CMS believes would be useful in supporting the documentation requirements for coverage of Lower Limb Prostheses."​

May/14/2013 Keep on Learning
May/09/2013 Oh-Fer For O&P
May/06/2013 L5930: Ancient History You Need to Know
May/02/2013 AFO Prepayment Audits...continued
Apr/25/2013 Another Way to Get Your Medicare Claim Denied Part 2: Delayed!
Apr/22/2013 Competitive Bidding Round 2: Key Facts
Apr/19/2013 May 1: Another Way to Get Your Medicare Claim Denied
Apr/18/2013 Our Error
Apr/03/2013 A Follows B
Apr/01/2013 2% Less
Mar/25/2013 Back to Back
Mar/19/2013 New Audit Issue…Watch Your Step
Mar/18/2013 New Name, Same Game
Mar/11/2013 Region A Says Prepay Prosthetic Reviews Here to Stay (For Now)
Feb/21/2013 More Info Required
Feb/07/2013 The RAC Annual Report: Behind the Headlines
Feb/07/2013 New and Improved
Feb/05/2013 The Coding Revolution
Jan/30/2013 Clarification from MAC Region B: "Hold on a sec!"
Jan/28/2013 Check Your Feet!
Jan/10/2013 To be continued
Jan/07/2013 Updates to Spinal Orthoses LCDs effective January 1, 2013
Jan/02/2013 Important Medicare Billing Info for 2013
Dec/21/2012 Severe Back Pain
Dec/19/2012 A Few Steps to Assist in AFO Claims Submission
Dec/17/2012 Physician Documentation: One Region’s Guidance
Dec/11/2012 Up. Down. Left. Right.
Dec/10/2012 Time is Money…
Jan/09/2014 Cleaning up documentation
Nov/30/2012 The Medicare Policy Manual: What You Have to Know (Part 1)
Nov/29/2012 The Economics of Insurance Companies
Nov/12/2012 Relief and Call to Action
Nov/06/2012 The 2013 L-Codes: A Summary
Oct/26/2012 The Error of Your Ways
Oct/15/2012 Cover Your Back
Oct/12/2012 OIG Report Examines Medicare Payments for Prosthetics and Custom Orthotics
Oct/03/2012 Important Miscellaneous Information
Sep/28/2012 Blue Card Changes
Sep/21/2012 “We're Not Gonna Take It Anymore”
Sep/20/2012 The Power of the Appeal
Sep/12/2012 ABNs Again
Sep/07/2012 Code Cracking
Sep/01/2012 Consolidation is a Side Effect of Health Care Reform
Aug/28/2012 Ten things to remember about TENS Device
Aug/24/2012 Running the Functional Level Gauntlet
Aug/17/2012 The Quest for Legible Signatures
Aug/13/2012 Region D Initiates Prepayment Review for Prosthetic L Codes
Aug/09/2012 PDAC Requirement Reversed: Is it Really a “Win”?
Aug/08/2012 PROPRIO FOOT Coding Explained
Aug/02/2012 Public-Private Cooperation Spells Higher Risk for Providers
Aug/01/2012 Össur R&R – An Introduction