legal

  1. M

    Question Can a modifier be added at the request of the insurer even if CMS/AMA guidelines don't require one?

    We have some CPTs that have been denied by an insurance company for "missing modifier". CPT 99291 was paid then the payment was recouped as "within global period". After our appeal, we received a letter that stated "the claim submitted did not have a modifier appended to the E/M service"...
  2. K

    seeing patients without ID

    Where I work we are allowed to check in patients without picture id providing they are cash pay. It concerns me that we are creating medical records and writing prescriptions for these patients. Do I have reason to be concerned or should I just relax?
  3. O

    NP in Credentialing Process

    Can anyone give me some advice on if we are in compliance by allowing our NP who is in the process of being credentialed(apps already submitted) to see the patients on her own without the provider going in the rooms with her but who is readily available to answer any questions she may have...
  4. T

    Ethics question/dilemma

    I am curious/concerned how much responsibility falls on the CPC of a billing office, if an audit were to occur, where the practice owner has demanded claims be sent in and someone else coded them. If a CPC knew the claims to most likely be faulty in some way but that CPC's name is not associated...
  5. T

    Question if FL Provider continue to treat patient if becomes non-par with Insurance

    I have a question regarding a cancellation of par status with insurance....can we offer to continue to treat patients if they elect to stay here and pay out of pocket due to NON_PAR status now with their Medicare Advantage Plans? I think if patient is aware and signs off saying they understand...
  6. M

    Need some serious advice for serious issue!

    During a routine maintenance of computer systems I.T. stumbled upon highly sensitive company communications going on via an employees personal, third party email account. Based on the nature and content of the emails that had popped up on the home screen, I.T. felt they had probable...
  7. S

    Making patients self pay vs billing ins

    Some staff in our office have contradicting opinions... Background: Our office doesn't accept new patients with a "xyz" insurance. But we are in network with the insurance and file for our current patients only. If a patient was originally a self pay patient, but now has "xyz" insurance...
  8. K

    Procedure 99188 and 99401

    Our physicians want to offer to our patient's dental evaluations and dental varnish in our office at same time they are doing a well check. The dental services would be for children 3 and under and for patient's who have a commercial insurance. Procedure codes are 99188 and 99401 dx Z41.8. We...
  9. O

    Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  10. Z

    Legal Question regarding a patient

    Hello all, I have a question about an issue that has been nagging in my mind for a few weeks. Any feedback would be appreciated. Note: I know we are not lawyers, and no input will be considered as legal counsel. I just want to know if I have reason to be concerned. I work for a 1 doctor/1...
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