Recently someone asked me why their Knee Orthosis claims are recently being denied, when they used to get paid. They stated they have done nothing different with their claims and process the same as always.

First of all, I asked them to fax a copy of the claim to my office to review so I can actually see how they submitted the claim. Long story short, I found errors on all of the claims (about a dozen), marked them up with corrections, refaxed them to them and they were resubmitted. She called yesterday and stated that all those claims have now been paid and thanked me...but, she had another claim that was denied for another type of Knee Orthosis.

First, I asked her what LCode she billed and what diagnosis code she used. She told me and based on the Medical Policies for KO's, she had the wrong diagnosis code for that particular LCode, which should automatically deny the claim. She is going to correspond with the referring physician regarding the corrected diagnosis code, if the physician concurs, she will correct the claim and resubmit.

With all this being said...It is my opinion that employees within Medicare have not been properly trained in the past. Since October 2008, every Thursday is Employee Training Day at Medicare and representatives are unavailable for a 2 hour period during their training. This is good and bad. Good that they are finally investing in employee training programs and executing...bad for billers who billed the "old school way".

It is imperative for Coders and Billers to stay on top of their game, and stay current with the latest trends and developments. Otherwise, it could cost your company a lot of money in unpaid claims and wasted time. Time is money in many cases, so words to the wise...do it right the first time!