CMS is proposing significant changes to certain appeal processes for Medicare beneficiaries. In this Q&A, Kimberly A. Hoy, JD, CPC, director of Medicare and compliance for HCPro LLC, in Chicago, explains how the rule could affect hospitals, including new required notices and potential billing process updates, and strategies for managing patient status changes.
Q: How do you bill operating room (OR), anesthesia, and recovery time for cosmetic and medically necessary procedures performed during the same encounter?
Q: Are we allowed to bill the facility evaluation and management (E/M) service if a patient was triaged then left without being seen (LWBS) by a physician/nonphysician practitioner?
Q: If a patient in the emergency department (ED) leaves without being seen (LWBS) by a physician/nonphysician practitioner, should we have facility charges?
