Ask the Expert

What sort of clinical integration does CMS expect between provider-based departments and hospitals?

Q: Is CPT code 96416 (chemotherapy administration requiring use of portable pump) the same as HCPCS code G0498 (initiation of infusion of chemotherapy in office using portable pump)? Our facility is trying to determine if it would be appropriate to set up G0498 as a Medicare override for 96416. 

Q: How can I hire the best case manager for my facility? 

How does CMS become aware of the existence of provider-based entities? Do hospitals need to report this information to CMS?

Q: I work in dermatology and need to know what documentation is required for excisions. We are struggling with getting paid.

Q: How can you best hold case management professionals accountable for deliverables?

How are place of service codes 19 and 22 used on claims for provider-based entities?

Q: We are currently coding a chart for an acute kidney injury which has the baseline serum creatinine and urine output missing from the chart. Is there something we can do before we have to query the physician?

Q: If we use a community transportation service for wheel chair transport, is the facility responsible?

Our experts answer questions about MUEs on HCPCS codes, appealing claims for noncovered procedures, and more.