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Billing / GA Medicaid Reason code 0984
« Last post by HPATEL on April 05, 2018, 10:24:44 AM »
I have a question how do we tackle denial code 0984 for Medicare crossover claim to Medicaid?

The denial claim states that Medicare Co-insurance more than 20 percent medicare allowed amount.

ex.
Medicare allowed $133.84. Medicare paid $103.88 after seq. reduction and all other.. 20% coninsurance is crossover to medicaid which is $26.77.
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Coding / Orthopedic PA visits in a nursing home
« Last post by Samiam18 on April 05, 2018, 02:54:42 AM »
I'm an orthopedic PA who will be seeing patients in nursing homes. I will be called for consultation for non-operative fractures (Ill be billing mostly fracture codes). What is the nursing home equivalent code for an initial office visit 99213? Also, can PAs from a private practice do consultations at nursing homes without the supervising physician ever seeing the patient?

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New! / Re: Can a Physician Have a Give Away?
« Last post by Michele on April 04, 2018, 06:47:16 AM »
I knew Linda would have some details for you!
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New! / Re: Can a Physician Have a Give Away?
« Last post by socaldk on April 03, 2018, 12:48:02 PM »
Thank you both! This is very helpful!
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New! / Re: Can a Physician Have a Give Away?
« Last post by PMRNC on April 03, 2018, 12:42:12 PM »
Under federal anti-kickback statutues there are expceptions for gifts and incentives such as:

The gifts must be “inexpensive” (i.e., a retail value of no more than $10 individually or $50 total annually per patient).
The gifts cannot be cash or eligible for cash equivalents.
You cannot give the gift with the intent of “securing your services to a patient.”

Now since these items/promotional gifts are being given whether the patient is a patient or not I'd say that you would be ok doing what your doing. I live in a small town and our local physicians office when it changed hands did something similar with an open house and everyone that attended got a small gift bag and there was a raffle of a $50 Bed Bath and Body Card. They didn't exclude anyone that may or may not have become a patient.

I would just make sure that there are not gifts or enticements for referals at all.
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New! / Re: Can a Physician Have a Give Away?
« Last post by Michele on April 03, 2018, 12:40:33 PM »
I think that it is ok.  I have been to open houses where they did giveaways.  Not to every person, but they did several giveaways.  Hopefully Linda will see this post.  She has more legal background than I do!
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NPI Numbers / Re: Billing for LPC-IT
« Last post by Michele on April 03, 2018, 12:35:05 PM »
The LPCs individual NPI would go under rendering provider, the group NPI would go under billing provider.
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General Questions / Re: Welcome Members!
« Last post by Michele on April 03, 2018, 12:13:08 PM »
Welcome!  Glad to have you on board.  :)
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New! / Can a Physician Have a Give Away?
« Last post by socaldk on April 03, 2018, 12:02:13 PM »
Hello All,

I am looking for some guidance for a client regarding a planned open house.

The doctor recently re-opened his practice. He wants to invite former patients to an open house where light refreshments would be served.

He also wants to "advertise" the idea that everyone that comes to the open house would receive a "gift", in this case a Starbucks card ($5.00) or so.

Is there a legal issue with doing such a promotion? *We are in MI (if that matters).

Thank you in advance!
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NPI Numbers / Re: Billing for LPC-IT
« Last post by Keis1225 on April 03, 2018, 11:09:11 AM »
What about once they are no longer interning, will they still bill under the LPC's NPI?  Or should they be using a group NPI?
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