Part B News | Ask a Part B News Expert

With secondary insurance, what COB says goes — or you may get stuck with the bill

10/14/2019

Question: A patient wants to use her secondary insurance as her primary insurance because it offers her a better price point. Are there any circumstances under which this is allowed?

If payers downcode lots of your E/Ms, check your work – and fight if you’re right

10/07/2019

by: Roy Edroso

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?

Master common repeat modifiers to prevent duplicate claim denials

09/23/2019

by: Richard Scott

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

Provider charged with child porn? Get him out, and follow the cops’ lead

09/23/2019

by: Roy Edroso

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?

How to report E/M office codes when the physician is new but the patient is not

09/16/2019

by: Jim Dresbach

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.

Providers leaving notes unsigned? Let them attest — or make them work weekends

07/29/2019

by: Roy Edroso

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?

Pivot to E/M codes when ear-wax removal fails to get the job done

07/29/2019

by: Richard Scott

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)?

Billing an outpatient who’s an inpatient? Bill where they’re admitted, not treated

07/08/2019

by: Laura Evans, CPC

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?

To avoid denials, ensure CCM initiating visit code G0506 goes beyond norm

07/01/2019

by: Richard Scott

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!

Focus on opioid review regardless of history, prescriber when reporting AWVs

05/06/2019

by: Richard Scott

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.

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