Got a question that needs an immediate answer? Stumped by ambiguous payer rules or challenging management decisions? Turn to our crack team of experts, who bring decades of hospital finance experience to the table.
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Q&A: Critical Access Hospitals
Oct 2008
Question: Are Critical Access Hospitals safe from a RAC audit?
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Observation and post op
Oct 2007
Q: When would you start charging observation hours post op if the order is written and the patient meets criteria?
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Hiring a patient access staff member
Oct 2007
Q. How many interviews should I conduct when filling a patient access staff position?
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Critical Access Hospitals and Medicare
Sep 2007
Q: What do critical access hospitals (CAHs) who have elected Method II have to provide to their fiscal intermediary (FI) to help determine eligibility for the primary care and specialty bonus?
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NPIs
Sep 2007
Q: Do medical students, interns, and residents need National Provider Identifiers (NPIs)?
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Scope of new Important Message from Medicare
Sep 2007
Q: Do the Important Message from Medicare and the Detailed Notice need to be given to all patients, regardless of the payment source? Do these documents need to be delivered to beneficiaries who have Medicare as a secondary payer? What about those dually eligible for both Medicare and Medicaid?
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Medicare makes changes to vaccine reimbursements
Aug 2007
Q: I heard that CMS is changing the way it reimburses vaccines. Can you provide any additional information?
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Just say no to identity theft
Aug 2007
Q: How can I eliminate identify theft or minimize the occurrence at our facility?
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Inpatient procedure billed as outpatient
Aug 2007
Q: We recently billed incision of the heart sac (33025) as an outpatient procedure. Medicare denied this claim on the grounds that this procedure is an inpatient-only procedure. What is the best way to handle this?
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Important Message from Medicare Notice: Inpatient transfers
Aug 2007
Q: Two hospitals have different Medicare ID (provider) numbers. Patients are transferred from one facility to the other for other inpatient care. Sometimes, patients are returned to the initiating facility, while other times they remain at the second facility to later be discharged or moved to a lower level of care. Does the sending hospital need to issue a follow-up copy of the Important Message from Medicare (IM)? Does the receiving facility need to issue a new IM?
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E-mailing patient information during registration processes
Jul 2007
Q: A provider affiliated with or employed by a covered entity would like to e-mail patient demographic information to the covered entity's registration department to expedite the registration process for his patients. Is this HIPAA-compliant?
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Can you report on more than one PQRI measure at the same visit?
Jul 2007
Q: Can you report on more than one PQRI measure at the same visit?
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How should we discipline staff who remove medical records from the facility?
Jul 2007
Q: What is an appropriate disciplinary action to enforce for staff members who take medical records out of the facility/office?
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Prepare for mandatory present on admission reporting
Jul 2007
Q: Do you have any information on the present on admission (POA) indicator? Is it required? Do we have to report it on the UB-04 form or on the 837? If so, which loop and segment?
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Are hospitals bound by InterQual criteria when determining patient status?
Jun 2007
Q: I have a question about what to do when a physician writes orders to admit a patient to the hospital as an inpatient, but the patient did not meet InterQual criteria for inpatient status.
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Can patient access staff give out ED information over the phone?
Jun 2007
Q: Can the hospital’s front desk receptionist give information to a caller asking whether a family member is in the emergency department?
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Any suggestions on non-scheduled patients who cannot make a deposit?
Jun 2007
Q: Do you have any suggestions on non-scheduled X-Rays and walk-in lab self-pay patients that cannot make a deposit on time of service?
At this time, our hospital sees all patients, so asking them to return is not an realistic option for us. But is that what most hospital do on non-stat outpatient walk-in patients?
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Can someone e-mail patient information to a registration department?
May 2007
Q: A provider affiliated with or employed by a covered entity would like to e-mail patient demographic information to the covered entity’s registration department to expedite the registration process for his patients. Is this HIPAA-compliant?
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Are we required to include a disclaimer on all faxes?
May 2007
Q: Does HIPAA require us to send a disclaimer with all faxes?
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Can physician move patient directly into observation after surgery?
May 2007
Q: We have come across cases in which the physician performs either a surgery or procedure on a patient, and then the physician places an order to admit the patient into observation.
Can the physician place the patient directly into observation without waiting four to six hours, as long as it is medically necessary?
And if so, what type of documentation in the medical records would be required to substantiate this type of action?
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HIPAA: Can we inform a teen's parents about child's hospital visit?
May 2007
Q: A 19-year-old presents an insurance card listing him or her as a qualified dependent on a parent's health plan.
If the parent calls for information about why the child was at the healthcare facility, can we release any information other than verifying the patient's presence?
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NPIs: Taxonomy code for psychiatric residents?
May 2007
Q: We are told that teaching hospitals must apply for NPIs for residents. What does one use for the taxonomy code for residents? We train psychiatric residents in an acute care hospital. I found no codes under the specialty of psychiatry for residents.
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Are we ready for hospital-branded credit cards?
Apr 2007
Q: What are your thoughts on the movement toward hospital-branded credit cards and how they may tie into the more savvy/educated consumer?
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Where is state transparency coming from?
Apr 2007
Q: Who is driving the push for state transparency? Is it generally a government authority or a special interest group or some other group?
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NPIs for teaching hospital residents?
Apr 2007
Q: Our hospital is a teaching hospital. Are our residents required to have an NPI?
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UB-04: Is box 70 the same diagnosis as box 69?
Apr 2007
Q: Could you please verify that box 70 is the same diagnosis as box 69? Also, what is box 81 a, b, c, and d? And what is the "qual" on boxes 76-79?
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UB-04: Is a 'how-to' manual available?
Mar 2007
Q: I would like to know if there is a manual explaining each box on the form and what information we need to enter? Is there a list of coding required as well? If so, how can we obtain one?
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UB-04: What is meant by 'service location?'
Mar 2007
Q: I've heard that "FL1" must be completed with the service location of the provider. For the UB-92, the prior field was for the "provider submitting the bill". Can you please explain more about what was meant by "service location?"
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UB-04
Mar 2007
Q: Regarding "FL15-Source of Referral for Admission or Visit," the definition in the UB-04 specifications is, "a code indicating the source of the referral for this admission or visit." The definition in the UB-92 specifications, that we currently use, is "code indicating the source of this admission or outpatient registration."
Is there a difference in how we should be using this field or not? Are we reading too much into the difference in verbiage?
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UB-04
Mar 2007
Q: Regarding the "FL14" field for "Priority Type of Visit" on the UB-04 form, is it needed on all patient types? Or is it needed just for inpatient and emergency room visits?
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UB-04: Nine or 10 characters for the Secondary Identifier field?
Mar 2007
Q: The UB-04 requirements are only for nine characters in fl76-fl79 line 1, Secondary Identifier field. But the Michigan state license, which is used for Blue Cross Blue Shield of Michigan (BCBSM) and all of our commercial payers, is 10 characters long. Can you explain why this is?
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UB-04
Feb 2007
Is 'reason for visit' a required field?
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UB-04
Feb 2007
Q: "Covered days," which is currently FL7 on the UB-92 form, will be identified as a value code 80 on the UB-04. Is this only a Medicare requirement? Will commercial and Medicaid payers require us to complete the value code?
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UB-04
Feb 2007
Is it OK to submit the standard three-digit bill type on a UB-04 form?
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Denials
Feb 2007
Q: Is there an effective strategy for ensuring that the appropriate admission status is ordered for surgery patients to avoid IP only denials?
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HIPAA
Jan 2007
Q: Is it a HIPAA violation to take files containing PHI out of the office to make preoperative/postoperative calls and deliver charts to an out-of-town physician's office for signature?
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NPI
Jan 2007
Q: We are a nursing home that does our own DMERC billing, so we have both a Medicare provider number and a DMERC provider number. Are we required to have two NPI numbers?
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HIPAA
Jan 2007
Q: Can we inform a patient of test results over the phone?
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Observation
Dec 2006
Q: If hospitals place too many patients in observation status, are they penalized by CMS?
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Observation
Nov 2006
The patient meets screening criteria at the time of presentation to the hospital and the patient was placed in observation. Twenty-four hours later, the patient was converted to an inpatient admission and did not meet screening criteria at that time. Can screening criteria that was met during the observation part of the hospital stay be used to approve the admission?
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Observation
Oct 2006
If a physician determines that a patient is acute and is not responding to treatment after a stay in outpatient observation, can the patient then be admitted as an inpatient?
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Observation
Oct 2006
If a physician writes a clear admission or outpatient observation order and the patient is receiving the level of care ordered, but an error by the business office or other staff results in an incorrect level of care designation being noted in the billing system, can this type of clerical transcription or designation error be corrected?
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Observation
Sep 2006
Q: If a hospital determines within a short period of time, after admitting a patient, that although the patient was acute on admission he or she has responded rapidly to treatment and is no longer acute, should the hospital bill the stay as an outpatient observation in order to prevent denial of a short stay or medically unnecessary admission?
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Observation
Sep 2006
Q: If a hospital determines within a short period of time, after admitting a patient, that although the patient was acute on admission he or she has responded rapidly to treatment and is no longer acute, should the hospital bill the stay as an outpatient observation in order to prevent denial of a short stay or medically unnecessary admission?
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Observation
Sep 2006
Q: When should observation orders be written?
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Routine care in outpatient observation?
Aug 2006
Q: Would it be permissible for a hospital to routinely care for all patients in outpatient observation prior to making a decision about their need for inpatient admission?
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Observation
Aug 2006
Would it be permissible for a hospital to routinely care for all patients in outpatient observation prior to making a decision about their need for inpatient admission?
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Observation
Aug 2006
What types of services would/would not qualify for outpatient observation?
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Observation
Aug 2006
Under what circumstances is use of outpatient observation appropriate?
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HIPAA
Jul 2006
Q: We prohibit employees, including physicians, from accessing their medical records in our electronic health record (EHR) without requesting them from health information management. Are we being too strict?
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HIPAA
Jul 2006
Can a provider disclose information related to a patient's alcohol and drug abuse or HIV status to an insurance company to obtain approval for admission, verify coverage, or submit a claim for payment purposes?
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HIPAA
Jul 2006
Can we disclose information about a patient's alcohol/drug abuse or HIV status to a payer to get approval for admission, verify coverage, or submit a claim?
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Billing
Jul 2006
Q: If we bill Medicare for a discontinued procedure, can we bill Managed Care the same way?
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Follow ABN guidelines for noncovered outpatient procedures
May 2006
Q: When a Medicare beneficiary presents for an outpatient procedure that we know is noncovered by Medicare, can we ask the patient for payment at the time of the service? If so, can we ask the patient to make a full payment? What about for a procedure that might not be covered and for which we deliver an advanced beneficiary notice (ABN)? Can we collect any payment at the time of service?
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Can you bill Managed Care as you bill Medicare for discontinued procedures?
May 2006
Q: If we bill Medicare for a discontinued procedure, can we bill Managed Care the same way?
Some consultants are telling us that commercial insurance must follow Medicare guidelines. Other consultants are telling us that Medicare is allowing this billing practice to anyone who is paid under OPPS, that the ability to bill discontinued procedures is not a federal guideline that Managed Care must follow, but a contract with Medicare. Managed Care does not pay under OPPS so we would not be able to bill Managed Care for discontinued procedures. Instead, we must follow each particular contract.
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Staffing ratios
Mar 2006
Q: I manage the billing department of an infusion company that does both infusion and durable medical equipment billing. Are there any benchmarks for staffing ratios, such as how many staff I should have for a specific volume of accounts? Our DSO hovers around 115 and our staff tell me they're "overworked," but how do I know for sure if they are or aren't?
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Consider these strategies to bill non-qualifying inpatient
Mar 2006
Q: If hospital staff perform a utilization review and the patient does not meet inpatient criteria, and also does not meet the standard to convert to observation through the use of condition code 44, what are a hospital's billing options? Can it do any of the below?
