Author Topic: AFO's  (Read 3399 times)

Pay_My_Claims

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AFO's
« on: September 06, 2009, 12:12:05 PM »
Ok, I have a neurologist who is prescribing AFO's for his clients. They have a biller in house who has been doing their billing for medical issues, but now they are dispensing DME. She has contacted me about doing the billing since they have not gotten paid for any of the AFO's since they began. I have already dx the problem and I can easily resolve their issues. My question is this...can they have me do the dme billing only or would I have to do the entire billing. I just don't think I can have them sign the agreement and both entities are submitting claims. Doing the Cash Recovery on the claims is one issue, but I think she wants me to handle all the DME billing and just let their current biller do just the medical. I appreciate your assistance


PMRNC

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Re: AFO's
« Reply #1 on: September 06, 2009, 07:31:59 PM »
Ok, you know I have to ask.. ? Isn't AFO Ankle, Foot Orthotic??  The Neurologist is billing for it? And is it that common for the Neurologist to bill that out routinely?? I'm confused! 
Linda Walker
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Pay_My_Claims

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Re: AFO's
« Reply #2 on: September 07, 2009, 04:04:55 PM »
Ok, you know I have to ask.. ? Isn't AFO Ankle, Foot Orthotic??  The Neurologist is billing for it? And is it that common for the Neurologist to bill that out routinely?? I'm confused! 

Yes AFO is ankle foot orthotic, and KAFO is knee ankle foot orthotid.  I don't know how common it is, but my neurologist actually billed for my c-pap. There are more and more physicians billing smaller dme supplies. They generally write a script, and have them go to a dme supplier and have it "filled". Now canes, walkers, braces, AFO's  diabetic supplies, shoes etc are not only being prescribed by the physician, podiatrist, etc they are being dispensed by them as well. There are neurological problems associated with the reasons people are given an AFO (drop foot can be als-ms, stoke, cp etc) All those are reasons you would see a neurologist. He can be treating you for a stroke which can cause abnormal gait and prescribe an AFO.

The big question for me is Can I bill her DME as a third party (Medical Billing Service) and her medical in-house biller still continue to bill the medical side of the business??

Pay_My_Claims

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Re: AFO's
« Reply #3 on: September 08, 2009, 10:09:30 AM »
Charlene,
 
Yes, it is OK for you to send claims on their behalf. However, you must have a CEDI submitter ID and the client's NPI must be linked to that ID.
 
Thanks,
 
National Government Services DME CEDI Help Desk
866-311-9184
M1

PMRNC

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Re: AFO's
« Reply #4 on: September 08, 2009, 11:10:23 AM »
You should check with your carriers because I ran into a problem with a provider who had a submitter ID with another billing company that was doing their claims, he wanted me to take over just the Medicare/Medicaid but again, I ran into a problem because according to that carrier (CT) we were not allowed to have two different Submitter IDs
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

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Re: AFO's
« Reply #5 on: September 08, 2009, 12:04:25 PM »
I am trying to tie up all ends since this is the first time I have encountered it, and I guess for most since I have posted the question everywhere and got no response. This was the reply from Medicare, but it still is evasive to me. I will find out soon enough, I am sure and will post the end results.


Pay_My_Claims

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Re: AFO's
« Reply #7 on: September 08, 2009, 12:24:58 PM »
Well, I'm going in and signing the provider. I have talked to Medicare, my software vendor and medicaid. (my biggest concerns). They say no problem!

Any issues I will be the guinea pig and let you all learn from me  ;D

PMRNC

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Re: AFO's
« Reply #8 on: September 08, 2009, 01:09:39 PM »
Charlene,
According to that link you posted.. the provider is only going to be assigned ONE Submitter ID, you mentioned only doing their DME only.. how is that going to work if the provider is only allowed ONE submitter ID?  This is almost identical to the problem I had with my one client for just their Medicare / Medicaid..and when I inquired to them they told me same thing "No problem" but as soon as we went to send claims is when we had problem.  This provider/client decided to have me do all of their billing so it finally worked itself out.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

margemib

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Re: AFO's
« Reply #9 on: September 08, 2009, 06:06:53 PM »
Charlene,
are you sending the claims directly to medicare for the provider?
because if you send it through your clearing house you don't need a submitter ID, am I wrong. Your clearing house has the ID.
margemib
Margie Finlay CMRS

Pay_My_Claims

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Re: AFO's
« Reply #10 on: September 08, 2009, 07:52:05 PM »
No, I am not sending them directly to Medicare and Yes, I am sending it through my clearing house. Yes I spoke to them and they stated no problem I was very clear that his practice would be billing claims using Medisoft, and I will using my software for the DME claims. I wanted to make sure that it was ok for 2 separate entities to send claims for 1 providers. Yes they have the submitter ID#.  Again I will see what happens, and be able to determine the outcome. My last resort is billing via remote log in . She is NOT going to remove her medical billing from the practice.