Medicare matters - Geriatrics

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Medicare Q & A: I have read that we should expect reductions in Medicare payments next year for family practice. Should I consider reducing the number of Medicare patients?

Jun 15, 2009
By:Don Self

Medicare is increasing amounts being paid for diagnostics and labs that family physicians perform. Physicians attuned to this are increasing their monthly net revenue by 30% or more.

Medicare Q & A: Can I bill Medicare for discussing end-of-life decisions with a patient?

Jun 15, 2009
By:Don Self

If more than half of the time spent with the patient was in counseling and/or coordination of care, use the CPT book to determine which level of visit code to bill.

Medicare Q & A: We have a Medicare patient who remains noncompliant and I would like to dismiss him as a patient, but can we do that with Medicare?

Jun 15, 2009
By:Don Self

You are allowed to dismiss or divorce a Medicare patient. To be safe, you should check with your malpractice carrier to find out your state requirements for the wording of the dismissal letter.

Medicare Q & A: We are seeing a patient from another state with a different carrier than the one we use. Which carrier do we bill?

Jun 15, 2009
By:Don Self

Always bill the Medicare carrier that has jurisdiction in the place of service (your office), regardless of where the patient lives.

Medicare Q & A: I was informed that Medicare no longer allows us to bill 15 to 27 months retroactively and that we are now limited to 30 days. Is this true?

Jun 15, 2009
By:Don Self

A physician practicing with a Medicare number back in 2007 can file claims through the end of 2009 for dates of service back to October 1, 2007.

Medicare Q & A: I joined an internal medicine practice that still uses the old style Advanced Beneficiary Notice. If we're audited, will we be in trouble?

Jun 15, 2009
By:Don Self

Billings for Medicare patients would have to be refunded if the new style Advanced Beneficiary Notice is not being used. It became mandatory for use on March 1, 2009.

Medicare Q & A: I make rounds on nursing home patients every 60 days, but sometimes patients have problems between my scheduled visits and I have to return to see them. Why can't I bill for these visits?

May 1, 2009
By:Don Self

You can bill for all nursing home visits that are medically necessary. There used to be a once-per-month limitation per patient; now medical necessity dictates whether you can bill.

Medicare Q & A: A patient who goes to the Emergency Department to have sutures placed may come to my office a week later to have the sutures removed. How do I bill for that?

May 1, 2009
By:Don Self

For suture removal, use office visit codes of low level, such as 99212. A modifier is not needed as long as you are not in the same group practice as the Emergency Department physician.

Medicare Q & A: I have patients on Coumadin and have their International Normalized Ratio (INR) checked weekly or twice per week, and adjust the dose if needed. Is there a way to bill for checking INR without seeing the patient in the office?

May 1, 2009
By:Don Self

You can't bill for PT/INR unless someone in your office is seeing the patient, because Medicare requires a face-to-face with the patient.

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