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Jurisdiction 1 Part A
FAQs


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How is a Federally Qualified Health Center (FQHC) supposed to bill for Part A core preventive services and how they are reimbursed?05/06/2013
If a Federally Qualified Health Center (FQHC) bills a core visit, is the payment for the drug included in their core service reimbursement? If they don’t bill a core visit and the patient only comes in for an injection, do they submit the drug to Part A or Part B?05/06/2013
We have a clinical pharmacist onsite that wants to talk to patients about their medications. Can the FQHC bill this service under Medicare Part A as a core visit?05/06/2013
The primary payer denied our claim because the service is not a covered benefit under that plan. Should I send a claim to Medicare for conditional payment?04/24/2013
Are National Coverage Determination (NCD) numbers referenced?04/17/2013
Are providers required to submit medical records to the Medicare Administrative Contractor (MAC) for RAC appeals?04/17/2013
As a SNF, are we responsible to contact the COBC to update CWF? Our patient refuses to contact the COBC.04/17/2013
CMS informed us that we did not need to submit one 855 form per NPI/Legacy combination. They said we could send one form with an attachment that contained all of the individual numbers. Is this correct?04/17/2013
Do you have a crosswalk in place for a legacy number to NPI?04/17/2013
Do you have questions about hospital claims overlapping?04/17/2013
Does a SNF need to provide both the SNF advance beneficiary notice or denial letter and the expedited review generic notice to patients when the facility determines the patient no longer requires a skilled level of care?04/17/2013
Does the 120-day rule apply in situations where information on the primary payer cannot be determined?04/17/2013
Does the off-label chemotherapy use policy apply to Hawaii and Nevada providers? If so, is there a new policy, and where can we find it?04/17/2013
Hospital Claim Coding Questions04/17/2013
How can I contact the medical director to discuss coding and reimbursement policy? Will the medical director speak locally once or twice a year?04/17/2013
How do I check on the status of my enrollment?04/17/2013
How do I get information about the Recovery Audit Contractor (RAC)?04/17/2013
How do I send RAC overpayments to Palmetto GBA?04/17/2013
How do we report a situation when the primary payer pays the patient directly?04/17/2013
How does Palmetto GBA decide when to request documentation, for what services and from whom?04/17/2013
How does Palmetto GBA handle Medically Unlikely Edits (MUEs)?04/17/2013
How should a skilled nursing facility (SNF) and/or swing bed submit a claim when therapy services are reduced?04/17/2013
I currently receive paper checks for my Medicare payments. Is this the safest way to receive payments?04/17/2013
If a patient has an open 'W' MSP file on CWF, we can bill the patient directly if the visit is related to the WC. Is this accurate?04/17/2013
Is Palmetto GBA reviewing the cap on the number of markers for flow cytometry, which is currently limited to 20?04/17/2013
Is there a new off-label chemotherapy use policy and when will it be posted? Where can we find it?04/17/2013
Is there a phone number we can call to talk to a person in provider enrollment?04/17/2013
Is there any special requirement when responding to several medical review requests at the same time?04/17/2013
It is time to update my Medicare enrollment information. Is there a way to ensure my personal information is secure?04/17/2013
Medicare was billed as secondary. Now the primary insurance is stating that Medicare should be primary and they are requesting their payment back. What do I need to do?04/17/2013
MSP Conditional Payment Claim Inquiries04/17/2013
Must value code 44 be reported when the provider has no contract with the payer that establishes payment at a certain amount?04/17/2013
Now that the RAC demonstration has ended, will there be any RAC related audits and recoupments in the future?04/17/2013
Should condition code 08 be used when the provider contacts the beneficiary by phone and mail multiple times but receives no response?04/17/2013
Some of my patients have open insurance records that they say are not valid anymore. Can you close these records so my claims will process?04/17/2013
Two of our providers had to renew their Medicare status. Can I still bill claims for them or do I have to wait until they are validated?04/17/2013
We are a SNF. A patient transferred to us from another SNF and the primary payer was paying due to an auto accident. The patient’s benefits exhausted under the primary payer. How should I bill Medicare?04/17/2013
We are a SNF. When Medicare is secondary, how do we know when the 100 days available in a benefit period exhaust?04/17/2013
We are an SNF. We have been sending MSP claims and the beneficiary has exhausted his/her 100 Medicare days and is at a skilled level of care. Must we continue to submit MSP claims?04/17/2013
We called the COBC to update the CWF but now the information is listed twice, under the name of the company and under liability. Will the claim be rejected?04/17/2013
We have services provided in both OR and NV under the single NPI. Are there any problems with this?04/17/2013
What are skilled nursing facilities (SNFs) passes (therapeutic leaves) for Medicare Part A residents?04/17/2013
What are some steps I can take to ensure my enrollment information is safe?04/17/2013
What if the CMS 855R application was signed by an unauthorized official?04/17/2013
What is the coverage for Pulmonary Rehabilitation? Which codes can be used?04/17/2013
What is the RAC appeal process?04/17/2013
When responding to a documentation requesting letter from the medical review department, what should be submitted besides the medical documentation?04/17/2013
When the medical review department conducts probe reviews, how are providers notified?04/17/2013
Which J1 LCDs apply to hospitals?04/17/2013
Who should I address additional questions to regarding the RAC?04/17/2013
Will there be an expansion of codes for services?04/17/2013
A PIP hospital provider received a demand letter requesting payment on a RAC DRG change that resulted in an overpayment. If the provider issues a check to Palmetto GBA and the claim is also adjusted in the FISS system, will we not be repaying the amount twice, both in the check issued and then upon cost report settlement?04/16/2013
Are cardiac rehabilitation programs covered by Medicare?04/16/2013
Are hospital labs that file institutional claims exempt from the MolDx Program requirements?04/16/2013
Can a provider request Healthcare Common Procedure Coding System (HCPCS) coding assistance from Palmetto GBA?04/16/2013
Can I fax the CMS 588 form to Palmetto GBA?04/16/2013
Can you please clarify the new instructions regarding the submission of Medicare Secondary Payer (MSP) claims through Direct Data Entry (DDE)?04/16/2013
Do hospitals receive a special add-on payment for blood clotting factors furnished to inpatients?04/16/2013
Does Medicare issue a letter indicating a patient's benefits are exhausted?04/16/2013
Does Palmetto GBA send hardcopy Remittance Advices (RAs) if we receive payment by EFT?04/16/2013
FAQs: Additional Medical Review Projects and CERT04/16/2013
How and when will we know our application was accepted for EFT?04/16/2013
How are we notified of an EFT payment?04/16/2013
How do I make the text larger to make it easier to read?04/16/2013
How often will the EFT RA be posted?04/16/2013
I have multiple applications to submit with all payments going to one bank account. Do I need to provide a voided check for each application?04/16/2013
I sent my application a few weeks ago and have not received a response. What do I need to do?04/16/2013
If an EFT form is sent back to correct, can we use white out to correct information?04/16/2013
If only the NPI number was put on the EFT application, will it be sent back?04/16/2013
In the future, will we be required to have EFTs? If so, when?04/16/2013
Is a CMS 855 application required to be submitted along with the CMS 588 EFT form?04/16/2013
On the CMS 588 I made a mistake. How do I correct the error?04/16/2013
The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests04/16/2013
What is the appropriate use of Occurrence code 42?04/16/2013
What is the effective date for the new occurrence code 55 used to report the date of death?04/16/2013
What is the time difference between EFT and paper checks?04/16/2013
Where can Skilled Nursing Facilities find current data concerning RUG weights and supporting data, the County/MSA/CBSA crosswalk file, and files for the Fiscal Year Software Releases?04/16/2013
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?04/15/2013
Do I need to submit a copy of the related LCD policy when requesting a redetermination?04/15/2013
Do we need to request permission to submit paper claims to Palmetto GBA?04/15/2013
Does my bank need to complete Part III, 'Depository Information (Financial Information)', on the CMS-588 Form?04/15/2013
How can I cancel receiving email updates?04/15/2013
How do I file an MSP claim now that DDE is no longer an option?04/15/2013
How do I sign up for Direct Data Entry?04/15/2013
How do we follow up on a claim already in the appeals process?04/15/2013
I am currently completing my initial enrollment application. Can I receive paper checks for Medicare payment?04/15/2013
I am enrolled in Medicare, and I am currently receiving paper checks. Can I still receive paper checks if I revalidate my enrollment?04/15/2013
I am re-enrolling in Medicare. Can I still receive paper checks for Medicare payment?04/15/2013
I receive paper checks and I am initiating a change to my provider enrollment information. Am I required to enroll in EFT?04/15/2013
I received a revalidation request and I am receiving paper checks. Can I continue receiving paper checks?04/15/2013
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last updated on 5/01/2013
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