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Jurisdiction 11 Part B
Frequently Asked Questions

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Medicare Secondary Payer (MSP) Frequently Asked Questions12/19/2014
Can we bill a patient for a service that denied due to MUE? Should we issue an Advance Beneficiary Notice (ABN) to the patient in this case?12/17/2014
Can we submit an appeal if we disagree with an Medically Unlikely Edit (MUE) denial?12/17/2014
My claim was denied with remittance messages N362 (The number of Days or Units of Service exceeds our acceptable maximum) and 151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services). What does that mean?12/17/2014
Our claim was denied for MUE. Can we request a reopening to change the units of service billed?12/17/2014
Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code?12/17/2014
Will ICD-10 testing be available for providers that use Palmetto GBA's online service rather than going through a clearinghouse?12/16/2014
After I receive a 277CA will I receive anything else?12/11/2014
Are Critical Access Hospitals (CAHs) subject to the outpatient therapy caps and thresholds in 2013?12/11/2014
Are there MSP examples available to view?12/11/2014
Can I appeal an outpatient therapy threshold prior authorization decision?12/11/2014
Can I submit ICD10 test files with my existing Submitter ID or do I have to obtain a new one?12/11/2014
Do you have any recommendations on software specifically for outpatient physical therapy?12/11/2014
Do you know if the physical address requirement is just for Medicare or all insurance?12/11/2014
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?12/11/2014
How can I search local coverage determinations (LCD) for a specific CPT/HCPCS code?12/11/2014
How Do I Find a Form?12/11/2014
How do I obtain my Continuing Education Unit (CEU) credit from a Palmetto GBA training session I attended?12/11/2014
How do we distinguish test from production submissions?12/11/2014
I heard that 5010 requires a physical address in box 33 and P.O. Boxes are no longer accepted. Is this true?12/11/2014
I received an adjusted claim stating 'Social Security records indicate that this patient was a prisoner when the service was rendered.' The patient is now deceased; how do I find which government entity is responsible for this claim?12/11/2014
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?12/11/2014
If we pass testing as a submitter, will we be able to submit claims for all our providers without them testing as well?12/11/2014
Is it acceptable to highlight information in the medical records when responding to a Medical Review Additional Documentation Request (ADR)?12/11/2014
Is the 277CA returned for each test submission?12/11/2014
Is the taxonomy code required in the 2000 loop for 5010?12/11/2014
Is there a certain type of claim that should to be submitted for ICD-10 testing?12/11/2014
Must we send a 270 v5010 to receive the 271 v5010?12/11/2014
My patient is no longer incarcerated, but the records have not been updated. Who do I need to contact to have the records updated?12/11/2014
New Therapy Cap Process: Frequently Asked Questions12/11/2014
PC-ACE Pro32 software FAQs12/11/2014
Previously, audio was available to attendees by either phone or PC. Are both features still available?12/11/2014
Revalidation Initiative: Frequently Asked Questions (FAQs)12/11/2014
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?12/11/2014
What if we do not receive the 999 and 277CA consistency?12/11/2014
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?12/11/2014
What is a Network Service Vendor?12/11/2014
What is an approved software vendor?12/11/2014
What is the most current version (date) of the 837 implementation guides?12/11/2014
When registering for the ICD-10 testing, if there is no confirmation email received is there another way the registration can be confirmed?12/11/2014
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?12/11/2014
Where is the 5010 certified vendor list on your website?12/11/2014
Who are the medical directors for J11?12/11/2014
Why was my redetermination request denied when I submitted a letter showing my patient was no longer incarcerated at the time of my service?12/11/2014
Will one test file allow me to move to PROD? And does the file require 25 claims?12/11/2014
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?12/11/2014
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?12/11/2014
Are observation codes submitted by the hour or by the calendar date?12/03/2014
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?12/03/2014
Are Your Medicare Secondary Claims Rejecting?12/03/2014
Can a nurse practitioner perform the initial hospital visit?12/03/2014
Can an evaluation and management (E/M) service be performed as a split/shared service?12/03/2014
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?12/03/2014
Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?12/03/2014
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?12/03/2014
Can time alone be used to select an E/M code?12/03/2014
Can we combine two different problems/diagnoses to obtain the HPI or can we only use one problem?12/03/2014
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?12/03/2014
How do I register for listservs?12/03/2014
How do I sign up for Twitter?12/03/2014
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?12/03/2014
How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?12/03/2014
I need information on receiving Twitter updates on my cell phone.12/03/2014
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?12/03/2014
I submitted an office visit and a surgery code on the same date of service. Why was the office visit denied?12/03/2014
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?12/03/2014
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?12/03/2014
If a provider sees a new patient and performs a comprehensive history, does the comprehensive history warrant submitting a higher level service?12/03/2014
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?12/03/2014
If my patient is registered in the emergency department and I am asked to see him/her, may I submit the emergency service?12/03/2014
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?12/03/2014
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?12/03/2014
Is a supervising physician’s signature required for services performed by a physician assistant in the emergency department?12/03/2014
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'?12/03/2014
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?12/03/2014
My paper claim was returned with a letter because I submitted a PTAN on the claim. Why wasn't my claim processed?12/03/2014
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?12/03/2014
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?12/03/2014
What are the differences between using Twitter to receive listserv messages and using email?12/03/2014
What are the documentation requirements for billing observation or inpatient hospital care services (including admission and discharge services)?12/03/2014
What do I tweet? What should I say?12/03/2014
What do these Twitter terms mean?12/03/2014
What if I can't get a handwritten or electronic signature because the provider is deceased or has left the practice?12/03/2014
What is medical review?12/03/2014
What is the definition of a 'new patient' when selecting an evaluation and management (E/M) CPT code?12/03/2014
What is the difference between the 1995 and 1997 Evaluation and Management (E/M) Guidelines?12/03/2014
What is Twitter?12/03/2014
What place of service (POS) do I use when reading a test from a remote location?12/03/2014
What should I do if I disagree with a letter of review findings for a review of medical records?12/03/2014
What specific information can ancillary staff (e.g., RN, LPN, CNA) document during an evaluation and management (E/M) encounter? Can ancillary staff act as a scribe for a provider?12/03/2014
When scoring documentation for E/M services, can a review or order of a pulse oximetry reading be counted as a vital sign under constitutional?12/03/2014
When submitting a diagnostic service for medical review, what documentation is required?12/03/2014
When submitting claims during ICD-10 testing how will a test file be distinguished from a production file?12/03/2014
When the history of present illness (HPI), review of systems (ROS) and past/family/social history (PFSH) are unobtainable, does a physician have to document the reason why or can it be inferred by other documentation within the history of present illness (HPI) (e.g., patient had severe dementia)?12/03/2014
When using the 1995 E/M guidelines, can you add body areas and organ systems together to determine the appropriate level for the examination component?12/03/2014
Where can I find a list of CARCs and RARCs?12/03/2014
Where can I order the new CMS 1500 (02/12) claim forms?12/03/2014
Why am I not eligible for the Primary Care Incentive Program (PCIP) payment?12/03/2014
Why do the links in my email listserv not work?12/03/2014
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last updated on 12/01/2014
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