Ask the Expert

How can we define the role of the nonlicensed case manager extender within our interdisciplinary team?

We found out after an observation patient was discharged that one of the procedures performed was an inpatient-only procedure. Can we bill this to Medicare without an official inpatient order on the medical record?

Our experts answer questions about diagnostic service coverage in hospitals, coding multi-part procedures, and more.

Q: It is my understanding that we can make PHI disclosures using our EHR for payment/treatment/healthcare operations without a consent and that we do not need to track these requests for an accounting of disclosures. Has this changed?

Q:  When it comes to conditions not related to hypertension, is it sufficient to attribute the diagnosis to another etiology or does the provider need to specifically document that the congestive heart failure (CHF) is not due to hypertension?

How should facilities approach claim edits that must be made across departments, such as imaging and surgery?

What is the recommended timeframe for applying edits to a claim?

Q: What's the distinction between the case manager and non-lincensed case manager extender?

Q: Our state child support enforcement agency requested the medical records of one of our pediatric patients. Are we allowed to respond to this request without a subpoena?

Our experts answer questions about acceptable documentation for HCCs, choosing the appropriate revenue code, and more.