Medicare

Can you please explain the Medicare Appeals process?

Orthotics are supposed to be statutorily not covered by Medicare unless they are attached to a brace. I was told to just append the KX modifier to the codes that are being billed for orthotics and I will get paid. Is this true and is it right to do this? Can I get in trouble?

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.

UNLESS THE FUNGUS INFECTION IN A NAIL REQUIRES DEBRIDEMENT BECAUSE IT CAUSED THE NAIL TO BE ABNORMALLY THICK WHICH RESULTED IN EITHER PAIN OR A SECONDARY INFECTION OR A MARKED LIMITATION OF WALKING, THE TREATMENT SERVICE IS CONSIDERED SIMPLY A NAIL TRIMMING AND IS NOT PAYABLE BY MEDICARE.

“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 is one to do when a patient wants a claim to be resubmitted after her deductible is met when the claim was originally submitted prior to the deductible being met?

What is the Active Care Requirement regarding “At Risk, Routine Foot Care?

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”