Compliance and reimbursement pearls | KRM Forum

Compliance and reimbursement pearls

Monthly column on billing and coding issues important to orthotic providers. These columns will provide you with a brief but thorough rationale on orthotic/prosthetic policies and billing practices.

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How do you know which HCPCS code to bill for an AFO Custom Fit or OTS - Part II
10/29/26, 12:47 PM • Paul Kesselman 10/29/26, 12:47 PM

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Paul Kesselman
10/29/26, 12:47 PM

The first segment of this two-part article provided some basic information on dual code...
L3000 Denials in Texas
10/22/26, 10:17 AM • Paul Kesselman 10/22/26, 10:17 AM

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Paul Kesselman
10/22/26, 10:17 AM

A recent PM Pulse story left me baffled for an answer and wondering if other Texas (or others) or...
How do you know which HCPCS code to bill for an AFO Custom Fit or OTS
10/15/26, 10:01 AM • Paul Kesselman 10/15/26, 10:01 AM

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Paul Kesselman
10/15/26, 10:01 AM

How do you know which HCPCS code to bill for an AFO, if there are two codes which Medicare has pr...
National Fraud Enforcement Division
10/1/26, 9:36 AM • Paul Kesselman 10/1/26, 9:36 AM

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Paul Kesselman
10/1/26, 9:36 AM

Unless you have been ignoring the news this past year, the fact that CMS and the Federal governme...
Back to Basics Coding Compliance for Foot Orthotics Part 2
9/24/26, 9:13 AM • Paul Kesselman 9/24/26, 9:13 AM

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Paul Kesselman
9/24/26, 9:13 AM

Last week’s coding and compliance column provided the most common HCPCS codes used to descr...
L3000 Anthem Audits
9/17/26, 8:08 AM • Paul Kesselman 9/17/26, 8:08 AM

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Paul Kesselman
9/17/26, 8:08 AM

Lately Anthem has started a nationwide recoupment on all orthotic claims particularly for L3000. ...
Back to Basics Coding Compliance for Foot Orthotics - Part 1
9/10/26, 8:56 AM • Paul Kesselman 9/10/26, 8:56 AM

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Paul Kesselman
9/10/26, 8:56 AM

Real life experiences often necessitate one look at the very basics and essence of one’s oc...
K Modifier
9/3/26, 10:02 AM • Paul Kesselman 9/3/26, 10:02 AM

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Paul Kesselman
9/3/26, 10:02 AM

This week’s column answers a question from a reader: "I recently billed for a L5020 Tibial...
PECOS Issues
8/27/26, 9:54 AM • Paul Kesselman 8/27/26, 9:54 AM

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Paul Kesselman
8/27/26, 9:54 AM

Hopefully, this will be the last article on enrollment for a while. My own recent personal experi...
CMS Launches Yet Another Reason for Providers To Take Enrollment Seriously
8/20/26, 10:38 AM • Paul Kesselman 8/20/26, 10:38 AM

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Paul Kesselman
8/20/26, 10:38 AM

On the heels of all the DME enrollment segments, CMS has announced several new, potenti...
A5512 vs A5513 or A5514
8/13/26, 12:00 PM • Paul Kesselman 8/13/26, 12:00 PM

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Paul Kesselman
8/13/26, 12:00 PM

This is a continuation of the past week’s discussion on whether there is a bell c...
A5512 vs A5514
8/5/26, 2:40 PM • Paul Kesselman 8/5/26, 2:40 PM

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Paul Kesselman
8/5/26, 2:40 PM

A colleague recently asked a question regarding the existence of a bell curve by which ...
AFO not in scope
7/30/26, 9:51 AM • Paul Kesselman 7/30/26, 9:51 AM

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Paul Kesselman
7/30/26, 9:51 AM

A colleague recently contacted me that a state carrier denied his claim for an AFO beca...
60K lost due to non complaince with reenrollment
7/16/26, 6:50 AM • Paul Kesselman 7/16/26, 6:50 AM

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Paul Kesselman
7/16/26, 6:50 AM

It’s truly amazing how the real world of DME enrollment tragedies continues, this...
When Medicare Says You Didn’t Write an Order to Yourself
7/10/26, 7:14 AM • Paul Kesselman 7/10/26, 7:14 AM

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Paul Kesselman
7/10/26, 7:14 AM

The other day, a physician who is also a certified coder called me with a Medicare audi...
The Orthopedic Surgeon Who Went to Prison Over an Enrollment Form
7/1/26, 10:08 AM • Paul Kesselman 7/1/26, 10:08 AM

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Paul Kesselman
7/1/26, 10:08 AM

An Orthopedic Surgeon Went to Prison Over a Medicare Enrollment Form. Seriously. Most doctors wo...
CEDI Front-End Rejections: Common Errors and Simple Fixes
6/25/26, 9:54 AM • Paul Kesselman 6/25/26, 9:54 AM

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Paul Kesselman
6/25/26, 9:54 AM

Every month the Common Electronic Data Interchange (CEDI) which electronically processes your DME...
When Same and Similar Meets Wedding Planning
6/17/26, 9:42 AM • Paul Kesselman 6/17/26, 9:42 AM

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Paul Kesselman
6/17/26, 9:42 AM

Not much has changed since this column began about the issue of Same and/or Similar. To pr...
Patients Status Post TMA: Addressing More Advanced Biomechanical Needs
6/11/26, 11:31 AM • Paul Kesselman 6/11/26, 11:31 AM

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Paul Kesselman
6/11/26, 11:31 AM

The first installment addressing the biomechanical needs of patients’ status post trans met...
Trans Metatarsal Amputation (TMA)
6/4/26, 8:30 AM • Paul Kesselman 6/4/26, 8:30 AM

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Paul Kesselman
6/4/26, 8:30 AM

A colleague asked are there common biomechanical traits and needs for patients who have undergone...

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Compliance and reimbursement pearls

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How do you know which HCPCS code to bill for an AFO Custom Fit or OTS - Part II

L3000 Denials in Texas

How do you know which HCPCS code to bill for an AFO Custom Fit or OTS