Compliance Question of the Week – General

What are the Medicare rules for a situation when two or more diagnoses equally meet the definition for principal diagnosis? For example, we had a patient who was admitted with systolic congestive heart failure exacerbation and aspiration pneumonia. Both are equally worked up (IV antibiotics, speech eval, NPO, IV Lasix, new echo, etc.).

How should we bill Medicare for active cardiopulmonary resuscitation (CPR) given to a patient who arrives at the emergency department (ED) and has a cardiac arrest on arrival? For example, should we bill critical care services or code 92950?

Can you explain the Medicare policy related to the term “mutually exclusive”?

If I receive a bundling message that says something is included in a service billed on the same day and I do not find evidence of this edit in the latest version update of the National Correct Coding Initiative (NCCI), who should I ask about this denial?

In the inpatient and outpatient charge data, what is the difference between “average charges” and “average total payments”?

Do anatomic considerations enter into CMS’s decision on the number of MUEs?

If a physician begins a cholecystectomy procedure using a laparoscopic approach but has to convert the procedure to an open abdominal approach, which approach would be reported?

Has CMS made any 2018 changes to the Medicare policy for supervision of hospital outpatient therapeutic services?

Is the use of virtual credit cards for health care claim payments covered by HIPAA transactions requirements?

If the final rules have been issued by CMS, can you provide the links to them?

Are the HCPCS code descriptions available in Spanish?

What is the difference between a health plan and a payer?