Part B News | Ask a Part B News Expert

You don’t need a ‘Refusal of Care’ form — but when patients refuse care, record it

09/14/2020

Question: I saw a recent report on telehealth that addresses a situation in which the telehealth patient refuses follow-up care. In the scenario, the patient is determined by the provider to require an office visit or a trip to the emergency room, but the patient refuses the follow-up. The authors say a “Refusal of Care” form should be filled out. We have never used such a form. Should we be doing this?

Use the fee schedule’s addendum B to winnow out procedures unsuited for the office

08/10/2020

by: Julia Kyles, CPC

Question: Do you know where we can find a list of procedures that are allowed in an office setting?

Despite PHE, provider signatures remain a must — except for ambulance orders

08/03/2020

by: Roy Edroso

Question: Like many practices, we’re doing a lot of telehealth during the public health emergency (PHE). Does this relieve or reduce our providers’ signature requirements for our Medicare claims?

Can you amend time on encounter notes? Yes — but don’t make a habit of it.

07/27/2020

by: Roy Edroso

Question: I have a doctor who’s billing critical care codes without putting the relevant times in his notes. We send these back to him and he amends them properly. Could this still be trouble for us down the road?

Generous MUEs for office visits haven’t changed the rules for same-day visits

07/20/2020

by: Julia Kyles, CPC

Question: I’m trying to figure out the impact of the new medically unlikely edits (MUE) for E/M codes 99201-99215. All codes have an MUE of 24. Does that mean a patient can see multiple physicians of the same specialty who bill under one tax ID on the same date of service? For example, could I bill two E/M visits if a patient saw Dr. Smith for shoulder pain and then saw Dr. Jones for knee pain?

Do Stark waivers cover your rent break? Only if the break meets ‘COVID-19 purposes.’

07/06/2020

by: Roy Edroso

Question: I understand there have been Stark Law waivers issued for the COVID-19 pandemic, and that one of the waivers covers rental arrangements that are under fair market value (FMV), which are usually forbidden under Stark. The shutdown has been hard on the finances of one of our clinics, and the health system that rents space to us, knowing it will be hard to find new tenants, has offered to forgive the rent on that clinic for a month or two to help it stay open. Would the Stark waivers allow such an arrangement?

Patients who get a COVID-19 test, and nothing more, stay ‘new’ for next visit

06/29/2020

by: Roy Edroso

Question: We’ve been running a clinic for COVID-19 tests where patients fill out forms and get tested. Some patients come back to the office for their results and sometimes, especially if the results are positive, they see the doctor. Are they a “new” patient at that point? Or are they established?

Review CMS’ definition of an OR before appending modifier 78

06/08/2020

by: Laura Evans

Question: I work for a group of general surgeons and quite often our patients are brought back into our office and taken to our patient rooms where an incision and drainage may be performed of a hematoma or a seroma. I have billing these with a 78 modifier. Now I am told that the 78 is used only if the patient is taken back to the hospital operating room.

Should you allow a patient companion in the exam room? That’s your call — mostly

06/01/2020

by: Roy Edroso

Question: There are times when patients want to be accompanied in the exam room by a family member or friend. Most of the time that’s fine, but sometimes I believe having another person in the room will make a discussion I think I should have with the patient more difficult. Is there any problem with my barring the entry of another person?

For ‘Welcome to Medicare’ exam, do your own vision screen or don’t bill

05/18/2020

by: Roy Edroso

Question: The initial preventive physical examination (IPPE) requires a “visual acuity” exam that we cannot request separate payment for. Some of our providers forget this simple step, and that prevents us from getting payment for the service they have performed other than that step. If a patient wears glasses and goes regularly to ophthalmologist for their routine eye exams, can we use this to meet the requirement?

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