Virginia Martin, CPC, CHBC

This month's question asks about effective dates and Medicare. Find out the answer to this pressing coding question.

Get your questions answered on marking up purchased services.

Various areas of coding, including PQRI measures, ophthalmology consults, are addressed

Questions and answers dig into preparedness for a potential H1N1 influenza pandemic.

There are a number of disease processes that must be managed, and doing so offers opportunities for reimbursement that you might not have been aware of.

No code has been assigned to report the administration of the upcoming H1N1 vaccine or the vaccine itself. Codes will likely be assigned around October 1.

Although Medicare is expected to offer a financial hardship exemption from electronic health records, the agency has offered scant details so far.

Physicians need to update the information related to their own NPI numbers. Failure to do so could result in not being paid for some services.

We have a physician leaving our practice and a new physician who is joining, and we are confused regarding how we should bill for services during this transition.

Patients need to understand their financial responsibilities, even if it means adding another layer of responsibility for your scheduling office.

It is possible to bill patients up front for the cost of treatment to get around slow third-party payments. But there is a lot to consider before going this route.

If nurse practitioners are going to treat patients outside the office, they should be credentialed independently, so they can bill their services under their own provider numbers.

A crossover is done on claims paid by Medicare based on the eligibility information reported.

Medicare will pay for treatment up to and including pronouncing time of death.

Some ZIP codes have more than one Medicare payment locality. These require the four-digit extension for payment to be rendered.

CMS has tweaked the rules on coding for its "Welcome to Medicare" program.

The physician should determine how to appropriately code sleep and polysomnography studies that are interrupted.

The window of opportunity to retroactively bill for services for a physician awaiting credentialing has been reduced from 27 months to 30 days.

To receive payment for arthrocentesis and related procedures, attach a modifier –59 to the successive services.

The rule requiring insurers to process claims with an NPI has created the necessity for providers to have one-no matter their circumstances.

Learn what you need to know to cut down on reimbursement hassles.

Mutually exclusive code edits play a role in whether procedures can be bundled.

The modifier -25 is not applicable to all emergency-type services performed in the office.

Medicare is usually the secondary payer, but not always. Check with the patient to see what other type of coverage is involved.

We're confused about billing chemotherapy hydration. Many times a patient will present in a very dehydrated state and require hydration therapy before we can begin infusion therapy. Other times, the hydration is part of the protocol for the infusion therapy. Is the coding different for these two scenarios?

A member of my group is fed up with Medicare. He has his Medicare patients sign an Advance Beneficiary Notice prior to rendering services, then the patients pay him and he tells the billing department not to file claims for those services. I'm concerned that what he's doing isn't correct, and that his actions will negatively affect the group. Am I overreacting?

Opting out; hydration therapy; rejected crossover claims