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Jurisdiction 11 Part A

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A Local Coverage Determination (LCD) is denoted as superseded on the CMS website. Please provide me with the advisory, notice or policy that gives the verbiage which supersedes this LCD. It is rumored that the supporting diagnosis codes have been revised, but there is no record I have found to verify this.07/21/2014
A patient has utilized 150 days of the Part A inpatient benefit and has also utilized 100 days of the skilled nursing facility (SNF) benefit of that benefit period. What does this mean?07/21/2014
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?07/21/2014
Aqua physical therapy is to be administered at the YMCA pool. Would the whole pool have to be completely closed to the public or would only half of the pool be closed while the other half of the pool is open and only used by the patient during that therapy session?07/21/2014
Are bariatric procedures not related to weight loss covered by Medicare?07/21/2014
Are cardiac rehabilitation programs covered by Medicare?07/21/2014
Are hospital labs that file institutional claims exempt from the MolDx Program requirements?07/21/2014
Are skilled nursing facilities required to bill Medicare for patients who have exhausted their Part A benefit?07/21/2014
Are we able to bill the CPT codes on the 12x type of bill (TOB) that would have been billed had this claim originally been submitted as an outpatient claim but were not allowed to be included on the inpatient claim which has been denied upon review, under the new A/B rebilling process?07/21/2014
Can a provider aggregate records and reply to more than one Additional Documentation Request (ADR) for a patient at the same time?07/21/2014
Can a provider bill a skilled nursing facility (SNF) or swing bed (SB) claim if the patient does not have a qualifying hospital stay?07/21/2014
Can an inpatient hospital stay in a Veteran’s Administration (VA) hospital be used to meet the Medicare Skilled Nursing Facility (SNF) 3-day qualifying stay in an inpatient hospital requirement?07/21/2014
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?07/21/2014
Can we find out if the outpatient therapy cap has been met through the Direct Data Entry system?07/21/2014
Change Request 8255 advises institutional providers to report the Clinical Trial Number on the claim, but I file a UB04 and it doesn’t state where to place this information. Can you advise?07/21/2014
Do hospitals receive a special add-on payment for blood clotting factors furnished to inpatients?07/21/2014
Do outpatient physical therapy facilities provide vaccinations?07/21/2014
Does Medicare issue a letter indicating a patient's benefits are exhausted?07/21/2014
For the new A/B Rebilling process, what should be billed on the 13x type of bill (TOB) versus on the 12 TOB?07/21/2014
How is a Federally Qualified Health Center (FQHC) supposed to bill for Part A core preventive services and how they are reimbursed?07/21/2014
How should I submit Part A biological response modifiers (BRM)/monoclonal antibodies administration?07/21/2014
How should units be billed for outpatient Bevacizumab (Avastin) services?07/21/2014
I am a provider and my Remittance Advice (RA) indicates a 935 withholding. Please explain.07/21/2014
I am aware that source of admission code 7 is no longer valid. What code replaces it?07/21/2014
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last updated on 7/01/2014
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