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Question: One of my payers is sending back a few dozen of our claims with the E/M codes downcoded from Level 4s to Level 3s. Is this common? Should we appeal? 

Question: I’ve recently received a spate of denials with duplicate claims messages. Why -- and what can I do to avoid this?


Question: I’ve just heard about a doctor at Cedars-Sinai who was removed from his post after he was formally charged with possession of child pornography. I’m interested to know: If we were, God forbid, to have such a situation at our practice, would we be able to remove the doctor, even if he hadn’t gone to trial and been found guilty? Also, what do we tell the patients?

Question: We have a new physician that has recently joined our surgical group. Some patients from her previous practice have elected to follow her to our practice. Are these patients considered new or established? The patients are new to our practice and tax ID number; however, they are not new to the physician who is providing care to them.
Question: Some of my doctors are signing their charts for claims very late weeks, even months late. Can I submit these claims? If a chart is signed too long after the encounter, is it invalidated?
Question: I have a common scenario that I encounter that I don’t know how to report. If my provider performs a technique to irrigate impacted cerumen in the clinic, but the removal of ear wax is not actually achieved, can I still report CPT code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral)?
Question: We have a patient who received outpatient care at our hospital clinic. This patient is also currently an inpatient in a rehab orthopedic hospital. We’re getting a Recovery Auditor (RAC) investigation on our charges for the patient stating we cannot bill an outpatient physician visit while the patient is an inpatient. (Our hospital bills an outpatient code on the rehab hospital’s inpatient bill.) The hospitals are both owned by the same system. What can we do?
Question: I’m seeing a lot of denials on my initiating visit claims for chronic care management (CCM) services. Is that because I’m reporting the CCM code with a routine E/M code? Do I need to wait for a specific date to bill? Please help!
Question: Regarding the recent updates from CMS, do we need to document “opioid review” in the wellness visit note if the patient has not recently been on opioids? We have a general “drug use” question on our wellness forms but nothing specific to opioids. Secondly, if the patient is on opioids prescribed by another provider, do we need to document opioid review? When our providers prescribe opioids, we always document review, alternative treatment, failed treatment, etc., so that is not a concern.

Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?


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