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David McGill Blogger

Region D Initiates Prepayment Review for Prosthetic L Codes

Posted by David McGill | August 13, 2012

MAC Region D (AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY) announced on Friday that it will be initiating a “widespread” prepayment review of claims utilizing codes L5673 (addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism) and L5301 (below knee, molded socket, shin, sach foot, endoskeletal system). In other words, nearly any claim for a below-knee prosthesis and/or a locking liner will fall within the scope of this prepayment review.

What can you do?

In the current environment, the question isn’t “what do I do to avoid prepayment review?”, but rather, “what do I do to successfully navigate it?” The key to a successful outcome on a prepayment review – especially one as far reaching as this one – is having a robust, repeatable claims process that captures all necessary documentation both from the prosthetist and the physician before you proceed to file your claim. The MAC Supplier Manuals (e.g., see Region D’s documentation requirements from Chapter 3 of its Supplier Manual here) and “Dear Physician” letters from last September outline these requirements clearly and comprehensively.

In addition, Össur Academy offers detailed seminars on exactly this topic. For more information about how to attend an upcoming seminar, please do not hesitate to contact your local Össur Area Manager for details.

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