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Jurisdiction 11 Part B
Frequently Asked Questions

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The patient's initial chiropractic visit was denied due to health history. What health history elements should be included in the initial chiropractic treatment visit history?11/21/2014
What is the correct billing for drug screens, specifically HCPCS code G0431?10/30/2014
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?10/13/2014
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)?10/13/2014
After I receive a 277CA will I receive anything else?10/13/2014
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?10/13/2014
Am I an Independent Diagnostic Testing Facility (IDTF)?10/13/2014
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?10/13/2014
Appeals: What happens to an incomplete redetermination request?10/13/2014
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?10/13/2014
Are Critical Access Hospitals (CAHs) subject to the outpatient therapy caps and thresholds in 2013?10/13/2014
Are health care providers required to comply with the CERT contractor’s request for medical records?10/13/2014
Are observation codes submitted by the hour or by the calendar date?10/13/2014
Are there any specific limits on the number of office visits Medicare will pay for each year?10/13/2014
Are there MSP examples available to view?10/13/2014
Are we required to submit a claim to Palmetto GBA for maintenance therapy?10/13/2014
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?10/13/2014
Are you required to submit therapy codes with both the GP and the GY HCPCS modifiers?10/13/2014
Are Your Medicare Secondary Claims Rejecting?10/13/2014
As a non-participating provider, why can I not charge up to the limiting charge if I accept assignment?10/13/2014
Can a chiropractor use a manual device to assist with manipulation?10/13/2014
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)?10/13/2014
Can a nurse practitioner perform the initial hospital visit?10/13/2014
Can a provider bill Medicare for missed appointments and receive reimbursement?10/13/2014
Can a provider submit a hospital inpatient or office/outpatient evaluation on the same calendar date as a critical service?10/13/2014
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?10/13/2014
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?10/13/2014
Can a psychologist order basic lab tests?10/13/2014
Can a psychologist order neuropsychological tests?10/13/2014
Can a single visit be counted as both the IPPE and an AWV?10/13/2014
Can a travel allowance fee be charged for medically necessary specimen collection from a nursing home or homebound patient?10/13/2014
Can an Anesthesiologist Assistant (AA) append HCPCS modifier QZ to an aesthesia service?10/13/2014
Can an attending physician and an office physician both submit a claim for their services?10/13/2014
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?10/13/2014
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?10/13/2014
Can an evaluation and management (E/M) service be performed as a split/shared service?10/13/2014
Can an independent diagnostic testing facility (IDTF) that functions as a mammography center receive Medicare reimbursement for percutaneous breast biopsy procedures and metallic localization clip placement?10/13/2014
Can ancillary staff that provides a service 'incident to' a physician or non-physician practitioner sign the documentation?10/13/2014
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.10/13/2014
Can I appeal an outpatient therapy threshold prior authorization decision?10/13/2014
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?10/13/2014
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?10/13/2014
Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?10/13/2014
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?10/13/2014
Can I submit a written reopening request to add a modifier to a claim that denied stating 'Social Security records indicate that this patient was a prisoner when the service was rendered?'10/13/2014
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?10/13/2014
Can I submit ICD10 test files with my existing Submitter ID or do I have to obtain a new one?10/13/2014
Can incident to occur in place of service (POS) 22 (outpatient hospital)?10/13/2014
Can other medical services be performed at the same time as an AWV? If so, how are they coded?10/13/2014
Can physical and occupational therapists both provide services to one patient at the same time?10/13/2014
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?10/13/2014
Can Psychotherapy Codes be Billed as Incident To?10/13/2014
Can the interpretation of an EKG be billed by the teaching physician if the residents are doing both the reading and interpretation?10/13/2014
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?10/13/2014
Can time alone be used to select an E/M code?10/13/2014
Can time be used as a basis for E/M code selection in regards to add-on psychotherapy services?10/13/2014
Can we combine two different problems/diagnoses to obtain the HPI or can we only use one problem?10/13/2014
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?10/13/2014
Can we utilize the 'status of three or more chronic/inactive conditions' as an extended History of Present Illness (HPI) for the 1995 guidelines?10/13/2014
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.?10/13/2014
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?10/13/2014
CMS Questions and AnswersOpen in New Window10/13/2014
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?10/13/2014
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?10/13/2014
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?10/13/2014
Do I need to send documentation for prolonged care code with each claim?10/13/2014
Do I need to submit a claim to Medicare for statutorily excluded services?10/13/2014
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?10/13/2014
Do subsequent visits need new treatment plans?10/13/2014
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?10/13/2014
Does a kidney transplant make Medicare primary from the date of the transplant?10/13/2014
Does Medicare cover hand therapy or pet therapy?10/13/2014
Does Medicare Part B cover Emend for postoperative nausea and vomiting (PONV)?10/13/2014
Does Medicare pay for unit dose medications for the COPD patients if they are in a nursing home facility?10/13/2014
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?10/13/2014
Does Medicare reimburse for ambulance transportation to and from a physician’s office?10/13/2014
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'?10/13/2014
Does Palmetto GBA cover electromagnetic wound therapy when delivered using MicroVas?10/13/2014
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6?10/13/2014
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?10/13/2014
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?10/13/2014
For outpatient therapy, how do I discharge or close out a reporting episode when the patient unexpectedly stops therapy? My patient called and said he does not think he needs any more therapy but came back in four weeks later for a different functional limitation. How do I close out the previous reporting episode before starting the new one?10/13/2014
Generally speaking, when we say 'objective measures,' what does that mean?10/13/2014
Generally speaking, when we say a 'treatment plan with specific goals', what does that mean?10/13/2014
Has your patient or their spouse experienced a loss of employment? How will this affect your Medicare payment?10/13/2014
How can I check the status of my Appeal request submitted through OPS?10/13/2014
How can I determine what codes/procedures are bundled with a certain code in the CCI edits?10/13/2014
How can I determine whether Medicare is the primary or secondary payer?10/13/2014
How can I obtain a Medigap listing?10/13/2014
How can I recognize a CERT contractor request for medical records?10/13/2014
How can I search local coverage determinations (LCD) for a specific CPT/HCPCS code?10/13/2014
How can Medicare Advantage plans (HMOs) affect your practice?10/13/2014
How do I change my address with Medicare since our practice is moving?10/13/2014
How do I determine which patient(s) is/are involved in an offset?10/13/2014
How Do I Find a Form?10/13/2014
How do I obtain my Continuing Education Unit (CEU) credit from a Palmetto GBA training session I attended?10/13/2014
How do I register for listservs?10/13/2014
How do I sign up for Twitter?10/13/2014
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last updated on 11/01/2014
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