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Jurisdiction 11 Part A

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A Group Health Plan (GHP) has recouped a primary payment on a claim processed over a year old indicating Medicare should have been primary. Will Medicare override timely filing rules and process an adjustment claim?07/01/2015
Are bariatric procedures not related to weight loss covered by Medicare?07/01/2015
Are cardiac rehabilitation programs covered by Medicare?07/01/2015
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?07/01/2015
Are hospital labs that file institutional claims exempt from the MolDx Program requirements?07/01/2015
Can a provider request Healthcare Common Procedure Coding System (HCPCS) coding assistance from Palmetto GBA?07/01/2015
Do Federally Qualified Health Centers (FQHCs) bill the Part A on the UB04 claim form for influenza and Pneumococcal Pneumonia Vaccinations (PPV) vaccinations?07/01/2015
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.07/01/2015
How do I sign up for Direct Data Entry?07/01/2015
How long does a provider have to submit medical records to the Comprehensive Error Rate Testing (CERT) Contractor for review?07/01/2015
I have a beneficiary who was part of a Medicare Advantage (MA) plan for part of their stay. How do I bill for their services?07/01/2015
If a hospital elects to report charges for recurring, non-repetitive services on a single bill, what must they report on the bill?07/01/2015
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?07/01/2015
If our pharmacy incorrectly reconstituted Herceptin (Trastuzumab) using sterile water instead of bacteriostatic water, and we are unable to store and use the rest of the vial, can our facility bill for the wasted drug and the administered amount?07/01/2015
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?07/01/2015
Is the administration for the flu and PPV vaccines reimbursed the same way?07/01/2015
Is there a limit to the number of claims that can be seen in the return to provider (RTP) status?07/01/2015
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.07/01/2015
Providers are currently beginning the recovery audit contractor (RAC) process. Where can providers find additional information regarding the RAC process?07/01/2015
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?07/01/2015
There used to be a list of HMOs on the CMS website. I can't find it now.07/01/2015
Using the Event Registration Portal07/01/2015
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?07/01/2015
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?07/01/2015
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last updated on 7/01/2015
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