Coverage/program guidelines met/exceeded

[lorig1369@gmail.com]

Can someone please help me w/this PRB5 denial? Is there any way to avoid this? I have the office staff ask the patient for DLS w/in 6 months and some don't go that often. I have an ABN signed. Is there any other way to avoid this denial? for routine foot care. Once I get a copy of the ABN or updated DLS can I simply submit a correct claim? This is such a huge part of my denials and besides calling the patients PCP for DLS I have no idea what else I can do. some patients even say "Oh I think it was in Feb. so I put 2/1/15 and if the DOS is 8/3/15 it bounces.. It is driving me crazy... Please help

 

[player14]

Our front office staff calls the patient's pcp before the patient even arrives for the visit. They then leave a billing note of that date in a certain location in the patient's EMR. The coder then locates that info so it can be entered on the claim when they get the charge. The office staff checks for this date in the patient's account for every scheduled foot care appt to make sure it's within the 6 month limit.

If the patient has been seen by another podiatrist recently, we would have them sign an ABN and bill out the code with modifier GA. Same situation if they have not been seen by their pcp in the last 6 months, I believe - but we have not encountered this before.

If the pt has a non-covered condition, we would then bill the code out with modifiers GY and GX. An ABN in not necessary in this case, but is considered best practice (GX - voluntary ABN issued).

ABN's need to be signed and dated prior to services rendered.

If you have a claim where you accidentally omitted the last visit date, you can fix the claim and resubmit it.

If you forgot the ABN modifier, you can add it and resubmit - as long as you are adhering to the rules of the ABN, and have all items needed if contacted by Medicare.

Podiatry calculator from Medicare NGS:
http://www.ngsmedicare.com/ngs/port...IwMDBydjQ0c3cz8DLz9jfULsh0VAf87fuA!/?LOB=Part B&LOC=Massachusetts&ngsLOC=Massachusetts&ngsLOB=Part B&jurisdiction=Jurisdiction K

Hope this helps!