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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?
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?
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.
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?
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?

Question: My providers saw a CMS announcement that practices may report audio-only telephone services. They believe this means they can report phone calls with the patient as telehealth E/M office visits. My interpretation of the guidelines is that they are pertinent to phone calls and that the telehealth codes billed with the usual E/M codes still require audio and video. Who is correct?

Question: I have some staff members at my practice, including a medical assistant, who are declining to work because they’re worried about catching COVID-19. Do they have the right to do that?
Question: The COVID-19 emergency has forced us to see nearly all our patients by telehealth only, and soon we may have to close down altogether, at least temporarily. Do we have to worry about patient abandonment trouble after this emergency lifts?
Question: A provider was using the new flexibility CMS offers to do telehealth visits by Skype when his transmission was interrupted and he had to finish the encounter by talking with the patient on the phone, with no visual component. He was conducting an E/M visit, and his notes suggest a 99212. Can I bill for that?

Question: A local candidate for political office wants his medical records from my office and states that he plans to release them to the public and wants his physician to make a statement about his health. Obviously, under HIPAA he has a right to the records, but is it appropriate for the physician to make such a statement?


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