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David McGill Blogger

Check Your Feet!

Posted by David McGill | January 28, 2013

MAC Region D has announced a widespread prepayment probe of 3 L codes: L5980, L5981, and L5987, all of which describe different prosthetic feet. The MAC states that the results of Comprehensive Error Rate Testing have led to this decision.

All Region D suppliers are subject to these reviews, and will receive an Additional Documentation Request letter asking for the following information, including but not limited to:

  • Treating MD's dispensing and written order;
  • Documentation of dispensing order (if the foot is dispensed based on the dispensing order);
  • Medical records supporting medical necessity (including MD records, PT records, etc.);
  • Functional level justification documentation;
  • Proof of delivery; and
  • Any Advanced Beneficiary Notice (if applicable).

What does this mean for you?

If you are a supplier in Region D, you have 45 days from receiving an Additional Documentation Request letter. If you fail to respond within that time frame, Medicare will deny your claim.

Therefore, your medical records must include the above information (to the extent it's in your file), and you should verify that supporting documentation exists in the files of other relevant medical professionals treating the patient (to the extent it's in theirs).

Also recognize that this will lead to longer stretches between delivery of the prosthetic foot to Medicare beneficiaries on the one hand, and payment by Medicare on the other. To the extent you have not already, you should be managing your cash flow accordingly.

Now more than ever, it's critical that you check your feet!

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