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Jurisdiction 11 Part B
Frequently Asked Questions

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May we fax documentation in response to Additional Documentation Request (ADR) letters using the fax attachments for electronic claims?05/15/2015
What should the date of service be when billing chronic care management services?05/15/2015
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?04/28/2015
Our physician will be out for 60 continuous calendar days. Will Medicare allow two different locum tenens physicians to substitute for the same regular physician?04/17/2015
After I receive a 277CA will I receive anything else?03/18/2015
Are there MSP examples available to view?03/18/2015
Do you have any recommendations on software specifically for outpatient physical therapy?03/18/2015
Do you know if the physical address requirement is just for Medicare or all insurance?03/18/2015
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?03/18/2015
How do we distinguish test from production submissions?03/18/2015
I heard that 5010 requires a physical address in box 33 and P.O. Boxes are no longer accepted. Is this true?03/18/2015
If we pass testing as a submitter, will we be able to submit claims for all our providers without them testing as well?03/18/2015
Is the 277CA returned for each test submission?03/18/2015
Is the taxonomy code required in the 2000 loop for 5010?03/18/2015
Must we send a 270 v5010 to receive the 271 v5010?03/18/2015
PC-ACE Pro32 software FAQs03/18/2015
What if we do not receive the 999 and 277CA consistency?03/18/2015
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?03/18/2015
What is a Network Service Vendor?03/18/2015
What is an approved software vendor?03/18/2015
What is the most current version (date) of the 837 implementation guides?03/18/2015
Where is the 5010 certified vendor list on your website?03/18/2015
Will one test file allow me to move to PROD? And does the file require 25 claims?03/18/2015
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?03/18/2015
Is AmnioFix covered by Medicare?03/12/2015
JW HCPCS Modifier: Frequently Asked Questions03/12/2015
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?03/12/2015
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)?03/10/2015
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?03/10/2015
Am I an Independent Diagnostic Testing Facility (IDTF)?03/10/2015
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?03/10/2015
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?03/10/2015
Are health care providers required to comply with the CERT contractor's request for medical records?03/10/2015
Are observation codes submitted by the hour or by the calendar date?03/10/2015
Are there any specific limits on the number of office visits Medicare will pay for each year?03/10/2015
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?03/10/2015
Are you required to submit therapy codes with both the GP and the GY HCPCS modifiers?03/10/2015
Are Your Medicare Secondary Claims Rejecting?03/10/2015
As a non-participating provider, why can I not charge up to the limiting charge if I accept assignment?03/10/2015
Can a chiropractor use a manual device to assist with manipulation?03/10/2015
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)?03/10/2015
Can a nurse practitioner perform the initial hospital visit?03/10/2015
Can a provider bill Medicare for missed appointments and receive reimbursement?03/10/2015
Can a provider submit a hospital inpatient or office/outpatient evaluation on the same calendar date as a critical service?03/10/2015
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?03/10/2015
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?03/10/2015
Can a psychologist order neuropsychological tests?03/10/2015
Can a travel allowance fee be charged for medically necessary specimen collection from a nursing home or homebound patient?03/10/2015
Can an Anesthesiologist Assistant (AA) append HCPCS modifier QZ to an aesthesia service?03/10/2015
Can an attending physician and an office physician both submit a claim for their services?03/10/2015
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?03/10/2015
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?03/10/2015
Can an evaluation and management (E/M) service be performed as a split/shared service?03/10/2015
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?03/10/2015
Can ancillary staff that provides a service 'incident to' a physician or non-physician practitioner sign the documentation?03/10/2015
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.03/10/2015
Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?03/10/2015
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?03/10/2015
Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?03/10/2015
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?03/10/2015
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?'03/10/2015
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?03/10/2015
Can incident to occur in place of service (POS) 22 (outpatient hospital)?03/10/2015
Can physical and occupational therapists both provide services to one patient at the same time?03/10/2015
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?03/10/2015
Can Psychotherapy Codes be Billed as Incident To?03/10/2015
Can the interpretation of an EKG be billed by the teaching physician if the residents are doing both the reading and interpretation?03/10/2015
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?03/10/2015
Can time alone be used to select an E/M code?03/10/2015
Can time be used as a basis for E/M code selection in regards to add-on psychotherapy services?03/10/2015
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?03/10/2015
Can we combine two different problems/diagnoses to obtain the HPI or can we only use one problem?03/10/2015
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?03/10/2015
Can we submit an appeal if we disagree with an Medically Unlikely Edit (MUE) denial?03/10/2015
Can we utilize the 'status of three or more chronic/inactive conditions' as an extended History of Present Illness (HPI) for the 1995 guidelines?03/10/2015
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.?03/10/2015
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?03/10/2015
CMS Questions and AnswersOpen in New Window03/10/2015
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?03/10/2015
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?03/10/2015
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?03/10/2015
Do I need to send documentation for prolonged care code with each claim?03/10/2015
Do I need to submit a claim to Medicare for statutorily excluded services?03/10/2015
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?03/10/2015
Do subsequent visits need new treatment plans?03/10/2015
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?03/10/2015
Does a kidney transplant make Medicare primary from the date of the transplant?03/10/2015
Does Medicare cover hand therapy or pet therapy?03/10/2015
Does Medicare Part B cover Emend for postoperative nausea and vomiting (PONV)?03/10/2015
Does Medicare pay for unit dose medications for the COPD patients if they are in a nursing home facility?03/10/2015
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?03/10/2015
Does Medicare reimburse for ambulance transportation to and from a physician's office?03/10/2015
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'?03/10/2015
Does Palmetto GBA cover electromagnetic wound therapy when delivered using MicroVas?03/10/2015
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6?03/10/2015
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?03/10/2015
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?03/10/2015
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?03/10/2015
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last updated on 5/01/2015
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