Compliance Question of the Week – General

What are Medicare rules on documentation of physician-patient telephone calls?

My question is a follow-up to last week’s question and answer about Medicare’s definition of a new patient. Would a patient still be considered “new” if only a diagnostic test was performed?

What is Medicare’s definition of “new patient” for billing evaluation and management (E&M) services?

Is there an appeal process for units of service (UOS) denied based on medically unlikely edits (MUEs)?

What is the effective date for the policy you reported in last week’s QA—the one related to reporting and charging requirements when a device is furnished without cost to the hospital etc.?

I have a comment to the answer posted to an April 10 question. You stated that, according to the Centers for Medicare & Medicaid Services (CMS), there is no cost to the hospital for a device being inserted and that modifier –FB must be appended to the procedure code (not the device code) under certain circumstances.

I had thought -FB was no longer a CMS requirement; rather the facility should utilize the correct condition code as well as the amount of credit in the “FD” value code?

When is the last program year for the PQRS?

Our hospital coding and CDI professionals have noticed an increase in length and redundancy in clinical documents since we have implemented the electronic health record (EHR). For ex., some physician progress notes have exploded from three lines in a paper record to three or more pages in an electronic record with information being copied and pasted. Do you have any suggestions on ways to deal with this problem?

One of our commercial insurers has denied our claims based on a “lack of clinical indicators.” We are assigning diagnostic codes based on the physician’s diagnostic statements. Should we be doing something else?

I have read that CMS will be developing “episode groups.” What are these?

For the Medicare program, what is the difference between fraud and abuse?

Is there a cost to the hospital if an implantable device that originally cost $20,000 fails and is replaced by a device that costs $16,000 and for which the manufacturer gives a credit of $16,000?