Medical Billing

Medicare Requirements for Home Health Care

Top Compliance Issues Webinar Q&A with Michael Warshaw, DPM, CPC

Can you please explain the Medicare Appeals process?

Does a patient have to be “Homebound” in order to provide foot care services in the patient’s home?

APPEALING MEDICARE DECSIONS Once an initial claim determination is made participating physicians generally have the right to appeal. Physicians who do not take assignment have limited appeal rights. Beneficiaries my assign their appeal rights to Physicians who provide them with services or items.

Peripheral Neuropathy is the most common factor leading to amputation in people with diabetes. In diabetes, peripheral neuropathy is an anatomically diffuse process primarily affecting sensory and autonomic fibers.

Routine Foot Care, which includes trimming or debridement of the asymptomatic, dystrophic, mycotic, or normal toenails are covered by Medicare only when the patient has one of the Medicare-specified systemic diseases with clinically significant peripheral complications placing the patient “At Risk” for infection and/or injury if a non-professional attempts to trim or debride the nail.

“If orthotics are not covered by Medicare, if the KX modifier is appended to L3000-RT and L3000-LT, I am getting paid. Is it wrong to use the KX modifier to get paid for orthotics?”

Updates Regarding CPT codes 11730 and 11750

What are the definitions of Modifiers 58, 76, 77, 78, 79 and how do they differ?