Office FAQ

Find answers to your questions on everyday issues affecting your practice.

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Office FAQ: Providing Services on the Same Day
If I provide an inpatient consult and then perform critical care services for the patient later that day, are those services eligible for separate reimbursement?
Office FAQ: Enrolling in PECOS as a Non-participating Provider
Am I required to enroll in Medicare’s Provider Enrollment Chain of Ownership System (PECOS) even if I am a non-participating (non-par) provider? If I do enroll, may I maintain my non-par status?
Office FAQ: Retaining Deceased Patients' Medical Records
Must physicians retain medical records of a deceased patient?
Office FAQ: Billing for Discharge Services
May a surgeon bill separately for a discharge service (CPT 99238)?
Office FAQ: Billing Medicaid for Services not Covered by Medicare
When you provide a service that is not covered by Medicare, such as a routine physical, to a qualified dual eligible Medicare beneficiary, can you submit the claim to Medicaid, their secondary payer?
Office FAQ: Billing Medicare as a Secondary Payer
When Medicare is the secondary payer (MSP), may an electronic biller drop the secondary claim to paper and submit to Medicare along with the primary payer’s explanation of benefits (EOB)?
Office FAQ: Medicaid Patients and Missed Appointments
May you charge a Medicaid recipient for a missed appointment?
Office FAQ: Limiting Practice to Medicaid Dual Eligibles
May I limit my participation in Medicaid to only providing services to dual eligible patients?
Office FAQ: PQRI Consecutive Reporting
If you choose the 30 consecutive patients reporting option for participation in PQRI and you miss or drop a patient in the process, can you start again?
Office FAQ: Billing for Family Meetings
May I bill for meeting with family members to discuss a patient's treatment when the patient is not present?
Office FAQ: Collecting Co-pays, Deductibles, and Coinsurance
Can a practice collect co-pays, deductibles, and coinsurance amounts from a patient prior to providing a service?
Office FAQ: Reporting Preventive Care Measures for FFS Patients
When reporting on the preventive care measures group for 30 consecutive Medicare Fee-for-Service (FFS) patients, do I need to submit the measures group specific G-code (G8486) on every patient?
Office FAQ: Medicare Advantage Plan Benefits
Are Medicare Advantage (MA) plans required to cover the same benefits as traditional Medicare Fee-For-Service (FFS)?
Office FAQ: Billing for Anticoagulation Management
What is the appropriate way to bill Medicare for outpatient anticoagulation management services?
Office FAQ: Sales and Use Tax
If our practice purchases transcription services and are not charged sales tax, are we obligated to report and remit the amount as use tax to the commonwealth?
Office FAQ: Medicaid Managed Care Plans
A provider who participates in the Medicaid Fee-for-Service program has provided a service to a patient enrolled in a Medicaid managed care plan with which the provider does not participate. Can the provider bill the patient for the service?
Office FAQ: Access Plus Pay-for-Performance Reporting
Will there be a standard form for physicians to fill out for Access Plus Pay-for-Performance measures?
Office FAQ: Professional Liability Requirements for CRNPs and PAs
What are the professional liability requirements for certified registered nurse practitioners (CRNP) and physician assistants (PA)?
Office FAQ: Retaining Financial Records
How long should I keep a patient's financial records?
Office FAQ: Non-custodial Parent's Request for Child's Medical Records
How should I handle a non-custodial parent's request for copies of her child's medical records when the custodial parent has asked our office not to fulfill the request?
Office FAQ: Request for Medical Records
May I refuse to transfer or give copies of a medical record for a patient with an outstanding balance for medical services?
Office FAQ: Being Dropped from Medicare Due to Inactivity
Is it possible for a physician to be dropped from Medicare due to inactivity?
Office FAQ: Terminate A Patient-Physician Relationship
What legal steps must a physician follow to terminate a patient-physician relationship?
Office FAQ: Withholding Patient Lists
Can a group practice withhold patient lists from a departing physician?
Office FAQ: Help with Administrative Hassles
How can the State Society’s Practice Economics and Payer Relations department help me?
Office FAQ: Verification Forms for Medicare Advantage Patients
Must our practice comply with a request from an insurer for certain medical diagnoses for Medicare Advantage (MA) patients, requiring us to fill out a “member condition verification form”?
Office FAQ: Patient Requests for Medical Records
When a patient requests her medical records be transferred or copied, must our practice include the entire record, or just the records for the care our practice provided?
Office FAQ: Medicare Part D
A lot of our patients need one-on-one help choosing a Part D prescription drug plan. Where can I get information for physicians, and where can I refer patients for help?
Office FAQ: Medicare Advantage Plans
Some Medicare patients are now coming in for appointments with their new Medicare Advantage plan information. We have decided not to participate with several of these new plans but are being told, since we participate with Medicare, we are required to participate in Medicare Advantage. Is this true?
Office FAQ: Downcoding Procedure Codes
We’ve noticed that, at times, insurers will change procedure codes on a claim we submit to them. This appears to be the practice of downcoding. Are they legally allowed to do this?
Office FAQ: Billing for No Shows
May a physician bill a patient for a “no show” appointment?