Part B News | Ask a Part B News Expert

Treating patients in the parking lot: You can, but proceed with caution

11/04/2019

Question: I saw a TV news story recently about how a doctor in Massachusetts treated patients in a parking lot when a power outage made her office unusable. “One patient, I saw in the car,” the doctor said. Was that a good idea? Shouldn’t they have sent their patients to another practice or rescheduled?

Complications drop off HCC risk scores if your provider doesn’t address them

10/28/2019

by: Roy Edroso

Question: Say a doctor sees a diabetic patient, notes blood sugar and increases the insulin dose. The chart includes diagnosis codes for diabetes mellitus (DM) with nephropathy (E11.21) and polyneuropathy (E11.42), but the notes do not otherwise address the polyneuropathy and nephropathy. For risk adjustment purposes, would this map to hierarchical condition category (HCC) 18 (Diabetes with chronic complications) or to HCC 19 (Diabetes without complication)? And if the nephropathy and polyneuropathy are not addressed in encounters, would the patient map to HCC 19, notwithstanding that he was diagnosed with them?

Teaching physicians find eased documentation standards for E/M services

10/28/2019

by: Richard Scott

Question: I saw a recent policy update from CMS about teaching physicians performing E/M services but I can’t understand what it means. Please help!

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

10/14/2019

by: Roy Edroso

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)?

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