October 21, 2013
It has been brought to our attention that Medicare has been conducting pre-payment audits of claims submitted for AFO devices. In a recent audit of twenty L-1970 claims, all were denied because they did not fulfill basic Medicare billing requirements. Protect yourself from claim rejection. Please be sure to follow basic claim requirements and complete all necessary documentation including:
- A prescription for the device which MUST include ALL of the following: Prescribing physician’s name, prescribing physician’s signature, beneficiary’s name, description of item, date of the order and the start date if the start date is different than the order date. Be sure to complete all required information on your Richie Brace Rx form before submitting it to Root Lab.
- Chart notes which indicate the medical condition (diagnosis) and the reason an AFO is needed (see All in One Medical Necessity Document).
- A document indicating the reason that a custom versus a pre-fabricated device is needed (see All in One Medical Necessity Document).
- Patient acknowledgement/proof of service (see Richie Brace AFO Receipt).
Click on the links below for forms provided by Douglas Richie, DPM to help practitioners with Medicare billing compliance as well as a copy of the Noridian report regarding this issue.
All in One Medical Necessity Document
Richie Brace AFO Receipt
Noridian report Aug. 2013
Disclaimer: This document does not warrant, verify or guarantee the validity or appropriateness of any billing codes or practices. The provider is solely responsible for proper billing of durable medical equipment and for the selection of the appropriate codes for reimbursement. Please check with your billing and coding service provider or consultant for billing compliance requirements.