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Jurisdiction 11 Part B
Frequently Asked Questions



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A patient is transported by ambulance to hospice prior to the initial assessment and development of the plan of care. Change Request 6778 states this transport would be covered under the ambulance benefit, not the hospice benefit. What destination modifier do I use?04/15/2014
Am I violating the Health Insurance Portability and Accountability Act (HIPAA) privacy rules by sending documentation to the CERT Documentation Contractor (CDC) and/or AdvanceMed?04/15/2014
Appeals: What happens to an incomplete redetermination request?04/15/2014
Are health care providers required to comply with the CERT contractor’s request for medical records?04/15/2014
Can a single visit be counted as both the IPPE and an AWV?04/15/2014
Can other medical services be performed at the same time as an AWV? If so, how are they coded?04/15/2014
Can you clarify the exact timeframe between Annual Wellness Visits (AWVs)? Is it 365 days from the date of the last AWV or 11 months, etc.?04/15/2014
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?04/15/2014
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?04/15/2014
Does Medicare reimburse for ambulance transportation to and from a physician’s office?04/15/2014
How can I recognize a CERT contractor request for medical records?04/15/2014
How does the CERT process work?04/15/2014
How is a claim selected and reviewed as part of the CERT process?04/15/2014
How is compliance with the CERT contractor's request for medical records beneficial to providers?04/15/2014
How is the CERT paid claims error rate determined?04/15/2014
How long does the CERT contractor have to review the medical records?04/15/2014
How will we be notified of the review decision?04/15/2014
I'm submitting post-op care only by using the appropriate modifier and procedure code. I am including the number of post-op days in the days/units field and the assumed/relinquished date in the electronic documentation record, but the service is not getting paid. Why?04/15/2014
I have a Physician Quality Reporting System (PQRS) code, formerly PQRI code, that is being returned as unprocessable with the message 'Missing/Incomplete/Invalid Charge.' Another code was returned stating 'Procedure code was invalid on the date of service.' Why won’t these codes process for 2011 dates of service?04/15/2014
I have an ambulatory surgical center (ASC) claim for brachytherapy treatment planning that was returned as unprocessable. The message states the claim was processed in accordance with ASC guidelines, but this code is on the ASC list of ancillary services that are separately payable. Why wasn’t the claim processed?04/15/2014
I have received a denial for my submission of specialty care transport HCPCS code A0434. What could be wrong?04/15/2014
I have received a primary payment for a consultation service. My software does not allow me to change the procedure code to an evaluation and management (E/M) code that Medicare will accept. Since Medicare no longer accepts consultation codes, can I bill the patient for the co-pay from the primary insurance and not submit a claim to Medicare?04/15/2014
I keep receiving denials from my vendor/clearinghouse whenever I submit MSP claims. The remittance advice indicates error message/required element 1044. Please assist with denial code.04/15/2014
I provided split post-op care to a patient who had cataract surgery by another doctor. I added the split post-op care modifier to my visit code, but the service was not paid. Why?04/15/2014
I received a denial for my submission of a specialty care transport code. What could be wrong?04/15/2014
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last updated on 4/01/2014
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