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Jurisdiction 11 Part A
FAQs



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Providers are currently beginning the recovery audit contractor (RAC) process. Where can providers find additional information regarding the RAC process?07/25/2014
We have begun to see a large amount of claims go into RTP due to reason code 36342. Can you provide any guidance? Should we move the drugs to non-covered until resolved so that we may get paid for the rest of the claims?07/25/2014
Are Critical Access Hospital (CAH) 85X type of bills (TOBs) editing for the 2014 Hospital Outpatient Prospective Payment System (PPS) Clinical Diagnostic Laboratory Test Payment and Billing rule per MLN Matters article MM8572?07/24/2014
Do Federally Qualified Health Centers (FQHCs) bill the Part A on the UB04 claim form for influenza and Pneumococcal Pneumonia Vaccinations (PPV) vaccinations?07/24/2014
FAQs: Additional Medical Review Projects and CERT07/24/2014
How do I enter three modifiers in Direct Data Entry (DDE)? There is no room to report the third modifier on Page 2 when keying a claim on DDE.07/24/2014
How long does a provider have to submit medical records to the Comprehensive Error Rate Testing (CERT) Contractor for review?07/24/2014
If a hospital elects to report charges for recurring, non-repetitive services on a single bill, what must they report on the bill?07/24/2014
If a patient is admitted into inpatient or skilled nursing facility care within 60 days of the benefits, does Medicare adjust claims to assign benefits sequentially for dates of service?07/24/2014
Is a dialysis facility required to submit the CMS-382 form if the patient receiving dialysis services does not have a Medicare number or is a Medicaid or private insurance beneficiary?07/24/2014
Is the administration for the flu and PPV vaccines reimbursed the same way?07/24/2014
Is there a limit to the number of claims that can be seen in the return to provider (RTP) status?07/24/2014
My claim contains HCPCS code C9399 (Unclassified drugs or biologicals), and received reason code 32512 indicating that the associated units must be equal to one. Please explain this reason code.07/24/2014
My claims are returning to provider (RTP) for reason code 32402, which states the claim date of service (DOS) is before the HCPCS effective date. If the assessments are generating the new RUG codes that came in effect October 1, 2010, should the claims bypass this edit, or what will the provider need to do to get this to process?07/24/2014
There is a field on the Remittance Advice entitled Hemophilia Add-On. What does this field report to Part A hospitals, and what generates this additional payment?07/24/2014
There used to be a list of HMOs on the CMS website. I can't find it now.07/24/2014
We had an outpatient therapy claim deny with reason code U5390 overlapping with a home health agency. How can we receive payment for therapy in this case?07/24/2014
We have a patient who recently terminated her HMO coverage and does not know her Medicare Number. I've called the contact center and tried to verify eligibility, but am told they are unable to verify Medicare eligibility with only an HMO member number. What can I do?07/24/2014
What condition code should end-stage renal disease facilities report to indicate home dialysis provided in a skilled nursing facility?07/24/2014
What does it mean when a HCPCS/CPT code is considered 'mutually exclusive' of each other?07/24/2014
What is interim billing for prospective payment system hospitals?07/24/2014
What is the maximum number of treatments that Medicare will pay for home hemodialysis training?07/24/2014
When a patient has preoperative diagnostic services two days before his/her inpatient surgery stay, am I able to bill a separate outpatient claim?07/24/2014
When do uncorrected return to provider (RTP) claims purge from the Fiscal Intermediary Shared System (FISS)?07/24/2014
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last updated on 7/01/2014
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