Billing > Billing

Diabetic Shoes

<< < (2/3) > >>

Ckilolo44@gmail.com:
The doctor is a Podiatrist and yes  we've been billing to the DMERC with
the correct modifiers.  The payments were coming in just fine, but about a year ago
we've been getting rejections.   I will have to get the EOB to see what specifically it says.
I will also check to see if it's the 1st or 2nd pair.

Michele:
Shanbull, I was able to open all of your links.

kristin:
Podiatrists can definitely be the ordering physician, but as shanbull points out, they cannot be the doctor who signs the Certifying Physician Statement, that has to be the MD/DO managing the diabetes. The treatment note that needs to be on file documenting the criteria the patient has that necessitates the shoes/inserts can be from either the DPM or MD/DO, but if it is from the DPM, it has to be signed/dated by the MD/DO signaling their concurrence with what the DPM has listed as the criteria.

I am curious to see what the denial reason is for these claims, because I think I have an idea already what is going on, and want to see if I am correct. A podiatrist I bill for remotely had a similar issue, starting about a year ago, and it turned out that DMERC was prepayment auditing every claim for shoes/inserts, but for some reason, the podiatrist either never got the prepayment audit request, or  sometimes they did, and staff filed it away without saying anything. So it wasn't until the claims denied after the paperwork the DMERC requested wasn't received that I figured out what was going on.

Then again, it could be something much easier to fix. LOL!

Michele:
Thanks for clarifying that.  I now see what this other provider was faced with.  The shoes/inserts were ordered by the DPM.  That was ok, but they needed to get the MD that was overseeing the patient to sign off on the CMN.  That is where they went wrong!  Well, it wasn't my problem, I just wondered what had happened.  Now I know!   ;D

Ckilolo44@gmail.com:
Ok, I want to be sure I have a clear understanding on the solution; the Primary doctor needs to sign off on CMN, not the Podiatrist?
Also, there have been no EOBs from Medicare on the accounts where Medicare was billed for the shoes. 

Navigation

[0] Message Index

[#] Next page

[*] Previous page