Ask the Expert

What are some guidelines for resolving procedure-to-procedure edits?

What guidelines should be followed when delivering the follow-up Important Message from Medicare?

What strategies can help case managers effectively communicate with low health literacy patients?

Q: Who should be responsible for coordinating the retrospective query process in a hospital? 

Can rural health clinics receive more than one all-inclusive rate payment per patient per day?

What is the best position on the executive team for the director of case management to report to?

Q. We acquired a home health agency and now employ home health nurses, physical therapists, speech therapists, etc. Can we permit workforce members to use their personal cell phones to communicate with patients? Is there a HIPAA-compliant means of doing so for calls, email, and text messages?

What laboratory services are covered under the rural health clinic benefit?

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?