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Jurisdiction 11 Part B
Frequently Asked Questions


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Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?05/09/2013
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?05/09/2013
Can a single visit be counted as both the IPPE and an AWV?04/17/2013
Can other medical services be performed at the same time as an AWV? If so, how are they coded?04/17/2013
Can you clarify the exact timeframe between Annual Wellness Visits (AWVs)? Is it 365 days from the date of the last AWV or 11 months, etc.?04/17/2013
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?04/17/2013
Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?04/17/2013
What are the appropriate procedure codes for the first and subsequent AWVs?04/17/2013
What causes a claim to be Unprocessable/Rejected?04/17/2013
When is a beneficiary eligible for the Annual Wellness Visit?04/17/2013
Who is the medical director for J11?04/17/2013
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?04/11/2013
A provider left our group. We have billed Locum Tenens for 60 days. If we use a different substitute physician every 60 days, can we continue to bill Locum Tenens under the exiting physician’s National Provider Identifier (NPI)?04/11/2013
After providing a consultation for a patient, the consulting physician receives an additional request (from the same referring physician or another referring physician) to see the same patient. Can the consulting physician submit an appropriate consultation CPT code for the second consultation?04/11/2013
After the employer has turned in the original questionnaire for the IRS/SSA/CMS Data Match purposes, what are the responsibilities of the employer to update this information? Who should be contacted?04/11/2013
Am I an Independent Diagnostic Testing Facility (IDTF)?04/11/2013
Am I violating the Health Insurance Portability and Accountability Act (HIPAA) privacy rules by sending documentation to the CERT Documentation Contractor (CDC) and/or AdvanceMed?04/11/2013
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?04/11/2013
Are Critical Access Hospitals (CAHs) subject to the outpatient therapy caps and thresholds in 2013?04/11/2013
Are health care providers required to comply with the CERT contractor’s request for medical records?04/11/2013
Are observation codes submitted by the hour or by the calendar date?04/11/2013
Are tetanus vaccines covered when treating a patient for an injury?04/11/2013
Are there any specific limits on the number of office visits Medicare will pay for each year?04/11/2013
Are we required to submit a claim to Palmetto GBA for maintenance therapy?04/11/2013
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?04/11/2013
Are Your Medicare Secondary Claims Rejecting?04/11/2013
As a non-participating provider, why can I not charge up to the limiting charge if I accept assignment?04/11/2013
Can a nurse practitioner perform the initial hospital visit?04/11/2013
Can a provider bill Medicare for missed appointments and receive reimbursement?04/11/2013
Can a provider submit a hospital inpatient or office/outpatient evaluation on the same calendar date as a critical service?04/11/2013
Can a provider submit charges for evaluation and management 'Level 4' office visit and prolonged care if the reason for the prolonged care was based on the patient requiring an interpreter?04/11/2013
Can a provider submit critical care services and a procedure on the same calendar date? Can you add the time spent performing these separately billable services towards the critical care time?04/11/2013
Can a psychologist order basic lab tests?04/11/2013
Can a psychologist order neuropsychological tests?04/11/2013
Can a specialist/surgeon refer a patient to his family physician for a pre-operative surgical clearance physical (the patient is established and known to the family physician)?04/11/2013
Can a travel allowance fee be charged for medically necessary specimen collection from a nursing home or homebound patient?04/11/2013
Can additional testing or treatment be initiated at an initial consultation visit and have the visit still considered a consult?04/11/2013
Can an attending physician and an office physician both submit a claim for their services?04/11/2013
Can an audiology service performed by an audiologist (technician) be submitted under the ENT physician’s provider number when the ENT physician is out of the office on vacation? Could this be an example of 'incident to' services?04/11/2013
Can an emergency department visit be submitted if the physician consults with the ER physician over the phone but does not actually come to the emergency department?04/11/2013
Can an evaluation and management (E/M) service be performed as a split/shared service?04/11/2013
Can an independent diagnostic testing facility (IDTF) that functions as a mammography center receive Medicare reimbursement for CPT codes 1XXXX (percutaneous breast biopsy procedures) and 1XXXX (metallic localization clip placement)?04/11/2013
Can ancillary staff that provides a service 'incident to' a physician or non-physician practitioner sign the documentation?04/11/2013
Can Dr. B. submit an initial visit in the following scenario? An ER physician sends a patient to be admitted and lists Dr. A. as the admitting physician. A resident performs the history and physical (H&P), followed by Dr. B., who sees the patient, reviews the H&P, and writes his notes. Dr. A. never sees or bills for any service for the patient.04/11/2013
Can I appeal an outpatient therapy threshold prior authorization decision?04/11/2013
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?04/11/2013
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?04/11/2013
Can physical and occupational therapists both provide services to one patient at the same time?04/11/2013
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?04/11/2013
Can the interpretation of an EKG be billed by the teaching physician if the residents are doing both the reading and interpretation?04/11/2013
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?04/11/2013
Can time alone be used to select an E/M code?04/11/2013
Can we combine two different problems/diagnoses to obtain the HPI or can we only use one problem?04/11/2013
Can we fax a primary payer's Explanation of Benefits (EOB) for Medicare Secondary Payer (MSP) claims using the fax attachments for electronic claims process described in the Medicare Advisory?04/11/2013
Can you clarify the minimum amount of time to establish the apnea-hypopnea index (AHI)? Is it two hours of recorded time or two hours of sleep time?04/11/2013
Can you provide clarification on consultation versus transfer of care?04/11/2013
CMS Questions and AnswersOpen in New Window04/11/2013
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?04/11/2013
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?04/11/2013
Do I need to enroll all of my offices in PECOS to continue ordering/referring for Medicare beneficiaries if I have offices in multiple states?04/11/2013
Do I need to send documentation for prolonged care code with each claim?04/11/2013
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?04/11/2013
Does a kidney transplant make Medicare primary from the date of the transplant?04/11/2013
Does a physician have to document the reason why the history of present illness (HPI), review of systems (ROS) and past/family/social history (PFSH) were unobtainable or can it be inferred by other documentation within the history of present illness (HPI) (e.g., patient had severe dementia)?04/11/2013
Does each provider have to fill out the Electronic Funds Transfer (EFT) form or can I just do one for the group?04/11/2013
Does Medicare cover hand therapy or pet therapy?04/11/2013
Does Medicare pay for unit dose medications for the COPD patients if they are in a nursing home facility?04/11/2013
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?04/11/2013
Does Medicare reimburse for ambulance transportation to and from a physician’s office?04/11/2013
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'?04/11/2013
Does Palmetto GBA cover electromagnetic wound therapy when delivered using MicroVas?04/11/2013
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6?04/11/2013
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?04/11/2013
Due to an adverse reaction to Rituximab, an infusion scheduled for over one hour was discontinued after 10 minutes. The physician conducted an examination and returned the patient to the care of the nurse for an additional hour of monitoring. Can we be reimbursed for the entire hour?04/11/2013
Has your patient or their spouse experienced a loss of employment? How will this affect your Medicare payment?04/11/2013
How can I check the status of my Appeal request submitted through OPS?04/11/2013
How can I determine what codes/procedures are bundled with a certain code in the CCI edits?04/11/2013
How can I determine whether Medicare is the primary or secondary payer?04/11/2013
How can I obtain a Medigap listing?04/11/2013
How can I recognize a CERT contractor request for medical records?04/11/2013
How can Medicare Advantage plans (HMOs) affect your practice?04/11/2013
How do I change my address with Medicare since our practice is moving?04/11/2013
How do I determine which patient(s) is/are involved in an offset?04/11/2013
How Do I Find a Form?04/11/2013
How do I obtain my Continuing Education Unit (CEU) credit from a Palmetto GBA training session I attended?04/11/2013
How do I register for listservs?04/11/2013
How do I sign up for Twitter?04/11/2013
How do I submit an Appeal online?04/11/2013
How do I upload attachments to an Appeal request?04/11/2013
How do Locum Tenens arrangements work?04/11/2013
How do you determine that a problem is a new problem or if it just an exacerbation of an established problem?04/11/2013
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?04/11/2013
How does Palmetto GBA decide when to request documentation, for what services and from whom?04/11/2013
How does the CERT process work?04/11/2013
How is a claim selected and reviewed as part of the CERT process?04/11/2013
How is compliance with the CERT contractor's request for medical records beneficial to providers?04/11/2013
How is the CERT paid claims error rate determined?04/11/2013
How long does the CERT contractor have to review the medical records?04/11/2013
How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?04/11/2013
How should a 'distinct procedural service' modifier be reported when there is a Correct Coding Initiative (CCI) edit?04/11/2013
see 25 | see 50 | see 100 Next Page >>

 

last updated on 5/01/2013
ver 1.0.37