Q: Are outpatient departments considered part of the therapy cap for hospital-owned facilities? If so, do we need to bill with modifier –KX (Type of Bill 012X)?
Q: We are trying to educate our coding department about medical necessity, but has CMS or Medicare defined it anywhere? How can we explain it to staff?
Q: Does a hospital need to obtain the patient's written consent before obtaining physician office notes? Can I contact the physician office and request the needed information without obtaining a written consent from the patient? The office notes are needed for payment purposes.
Does case management need to be a seven-day-a-week service, or can the service succeed with coverage five days per week? As a case manager, I need to retain staff but also provide some consistency to the patients.
Q: Our facility does not have a standard appeal letter template to respond to medical necessity denials. Do you have any suggestions for how to respond?
