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Jurisdiction 11 Part B
Frequently Asked Questions



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I am a Medicare Periodic Interim Payment (PIP) provider that had claims affected by the incarcerated beneficiary take backs and I still have not received my refund for these claims. Can you tell me when I should expect to receive the refund?09/18/2014
I was late to the Webinar and missed information presented at the beginning. Is there a way for me to watch the session in its entirety later?09/17/2014
If I am uncertain as to whether Medicare or the CERT contractor can read my doctor's signature may I voluntarily submit a signature log when asked to provide documentation?09/17/2014
Is AmnioFix covered by Medicare?09/17/2014
JW HCPCS Modifier: Frequently Asked Questions09/17/2014
My remittance advice (RA) contained code LE - Levy. What does this mean?09/17/2014
What does forwarding balance mean on my remittance notice?09/17/2014
What is the impact of the Part A to Part B rebilling process for CMS 1500-Claim forms when the place of services is changed from an outpatient to an inpatient status? Would the physician still get paid for the inpatient level of care or will claims need to be adjusted with the new place of service?09/17/2014
Are there MSP examples available to view?09/16/2014
Do you have any recommendations on software specifically for outpatient physical therapy?09/16/2014
Do you know if the physical address requirement is just for Medicare or all insurance?09/16/2014
For physical therapy claims where the service is performed in the patient's home (PS=12), does there need to be a 2310C loop with the patient's home address? If so, does is it need a 9-digit zip code?09/16/2014
How do we distinguish test from production submissions?09/16/2014
I heard that 5010 requires a physical address in box 33 and P.O. Boxes are no longer accepted. Is this true?09/16/2014
If we pass testing as a submitter, will we be able to submit claims for all our providers without them testing as well?09/16/2014
Is the 277CA returned for each test submission?09/16/2014
Is the taxonomy code required in the 2000 loop for 5010?09/16/2014
Must we send a 270 v5010 to receive the 271 v5010?09/16/2014
PC-ACE Pro32 software FAQs09/16/2014
What if we do not receive the 999 and 277CA consistency?09/16/2014
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?09/16/2014
What is an approved software vendor?09/16/2014
What is the most current version (date) of the 837 implementation guides?09/16/2014
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?09/16/2014
Where is the 5010 certified vendor list on your website?09/16/2014
Will one test file allow me to move to PROD? And does the file require 25 claims?09/16/2014
Will you reject claims with a P.O. Box in the billing provider address? Will you reject claims where the group number and policy number are the same values?09/16/2014
Are Critical Access Hospitals (CAHs) subject to the outpatient therapy caps and thresholds in 2013?09/12/2014
Can I appeal an outpatient therapy threshold prior authorization decision?09/12/2014
Can I submit ICD10 test files with my existing Submitter ID or do I have to obtain a new one?09/12/2014
How can I search local coverage determinations (LCD) for a specific CPT/HCPCS code?09/12/2014
How Do I Find a Form?09/12/2014
Is it acceptable to highlight information in the medical records when responding to a Medical Review Additional Documentation Request (ADR)?09/12/2014
Revalidation Initiative: Frequently Asked Questions (FAQs)09/12/2014
Will the KX HCPCS modifier still be used on claims that have reached the $3700 outpatient therapy threshold along with the tracking number(s) for prior authorization of the services?09/12/2014
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?09/11/2014
Appeals: What happens to an incomplete redetermination request?09/11/2014
Are observation codes submitted by the hour or by the calendar date?09/11/2014
Are we required to submit a claim to Palmetto GBA for maintenance therapy?09/11/2014
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?09/11/2014
Are Your Medicare Secondary Claims Rejecting?09/11/2014
Can a nurse practitioner perform the initial hospital visit?09/11/2014
Can a provider submit a hospital inpatient or office/outpatient evaluation on the same calendar date as a critical service?09/11/2014
Can a single visit be counted as both the IPPE and an AWV?09/11/2014
Can an evaluation and management (E/M) service be performed as a split/shared service?09/11/2014
Can ancillary staff that provides a service 'incident to' a physician or non-physician practitioner sign the documentation?09/11/2014
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?09/11/2014
Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?09/11/2014
Can I submit a subsequent nursing facility CPT code if my documentation does not support one of the three levels of initial nursing facility services?09/11/2014
Can incident to occur in place of service (POS) 22 (outpatient hospital)?09/11/2014
Can other medical services be performed at the same time as an AWV? If so, how are they coded?09/11/2014
Can the modifier that indicates 'increased procedural services' be submitted with an E/M service when a physician spends an extended amount of time with a patient?09/11/2014
Can time alone be used to select an E/M code?09/11/2014
Can we combine two different problems/diagnoses to obtain the HPI or can we only use one problem?09/11/2014
Can we utilize the 'status of three or more chronic/inactive conditions' as an extended History of Present Illness (HPI) for the 1995 guidelines?09/11/2014
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?09/11/2014
Generally speaking, when we say 'objective measures,' what does that mean?09/11/2014
Generally speaking, when we say a 'treatment plan with specific goals', what does that mean?09/11/2014
How can I check the status of my Appeal request submitted through OPS?09/11/2014
How do I obtain my Continuing Education Unit (CEU) credit from a Palmetto GBA training session I attended?09/11/2014
How do I register for listservs?09/11/2014
How do I sign up for Twitter?09/11/2014
How do I submit an Appeal online?09/11/2014
How do I upload attachments to an Appeal request?09/11/2014
How does a chiropractor submit a claim for an office visit and X-rays to Medicare for the denial of statutorily excluded services for the patient’s secondary insurance company?09/11/2014
How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?09/11/2014
How often are CARCs and RARCs updated?09/11/2014
How will I know my Appeal request has been received in OPS?09/11/2014
I noticed a 'multiple procedure' modifier on my remittance advice but I did not submit it. The service was allowed, but should I have included this modifier on my claim?09/11/2014
I submitted an office visit and a surgery code on the same date of service. Why was the office visit denied?09/11/2014
I was late to the webcast and missed information presented at the beginning. Is there a way for me to watch the session in its entirety later?09/11/2014
If a patient had one system complaint that was documented for the review of systems (ROS) and then the provider documented: 'patient has no other complaints', is that enough to receive a complete ROS?09/11/2014
If a physician has recorded a review of systems (ROS) and past, family and social history (PFSH) on a previous encounter, does the physician need to re-record this information?09/11/2014
If a provider administers Tylenol in the emergency room, is the level of risk considered 'low' under management option(s)?09/11/2014
If a provider sees a new patient and performs a comprehensive history, does the comprehensive history warrant submitting a higher level service?09/11/2014
If an established patient presents to the office for a visit with a non-physician practitioner (NPP), and during the encounter the patient has a new problem/condition, can this service be submitted 'incident to'? What if the NPP only orders tests, but does not establish a plan of care?09/11/2014
If I document 'no edema present' or 'Extremities: No edema noted,' would 'credit' be given for both upper and lower extremities?09/11/2014
If my patient is registered in the emergency department and I am asked to see him/her, may I submit the emergency service?09/11/2014
If the physician elects to report the level of service based on counseling and/or coordination of care, does the total length of time of the encounter (face-to-face or floor time, as appropriate) need to be documented?09/11/2014
In the E/M documentation guidelines, what does 'more detail' regarding the exam mean, and what is the difference between an expanded problem-focused exam and detailed exam?09/11/2014
In the Table of Risk, under the diagnostic procedures ordered, where would you give credit for collecting a Pap smear?09/11/2014
Is a supervising physician’s signature required for services performed by a physician assistant in the emergency department?09/11/2014
Is an intravenous insulin drip considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk?09/11/2014
Is Coumadin or Heparin considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk?09/11/2014
Is it acceptable to document 'VSS' (vital signs stable)? How many vital signs must be listed in order to receive 'credit' for the 1995 guidelines under 'constitutional'?09/11/2014
Is it acceptable to use 'noncontributory, unremarkable or negative' when reporting past, family or social history?09/11/2014
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?09/11/2014
Is there a certain type of claim that should to be submitted for ICD-10 testing?09/11/2014
Must a problem be new to the patient or new to the provider in order for it to be considered a 'new problem' when scoring diagnosis/management options for an evaluation and management (E/M) service?09/11/2014
My paper claim was rejected with message N34, incorrect claim form/format for this service. What is wrong with my claim form?09/11/2014
My paper claim was returned with a letter because I submitted a PTAN on the claim. Why wasn't my claim processed?09/11/2014
My therapy claim was rejected with remittance message N572. What is wrong?09/11/2014
One physician in a group performed a surgical procedure but a different physician in the same group was responsible for follow up after the surgery. Do we submit as split post-op care?09/11/2014
Payment was reduced (down coded) for E/M services because the documentation was not legible to the reviewer. What should I include in an appeal request?09/11/2014
Previously, audio was available to attendees by either phone or PC. Are both features still available?09/11/2014
Should the admitting physician submit HCPCS modifier AI (Principal Physician of Record) when there is no other physician submitting an initial hospital or nursing home visit code?09/11/2014
We assume there will be at minimum a different port number and possibly a different IP address to use during ICD-10 testing. Who will be providing this info to each provider/payor? Is that the Medicare Administrative Contractors (MAC's) responsibility?09/11/2014
What are CARCs and RARCs?09/11/2014
What are the appropriate procedure codes for the first and subsequent AWVs?09/11/2014
What are the differences between using Twitter to receive listserv messages and using email?09/11/2014
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last updated on 9/01/2014
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