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kristin:
Agree with Richard, he said exactly what I was going to say.

RichardP:
 :)

danielmanske:
Thank you for your thoughtful response, Richard.  We live in a poor area and our mostly pediatric patients have Medicaid HMO coverage.  So if the contract does not spell out requirements that differ from the AMA coding/billing books then they apply, right.  They can't enforce something other than our contract or the AMA rule books looking back.  That's what they seem to want to do, enforce convention over the AMA books since it's not specified in our contract. 

RichardP:
Medicaid is governed by both State and Federal law.  At this point, you would probably be wise to be asking questions of a HealthCare Attorney from your state rather than from this billing board.

danielmanske:
Noted, thank you, Richard.  I think it's worthy of discussion as a challenge and to see what arguments might be in play.  I've seen nothing here to refute my interpretation.

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