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Jurisdiction 11 Part B
Frequently Asked Questions

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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)?01/20/2015
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?01/20/2015
Am I an Independent Diagnostic Testing Facility (IDTF)?01/20/2015
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?01/20/2015
Appeals: What happens to an incomplete redetermination request?01/20/2015
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?01/20/2015
Are health care providers required to comply with the CERT contractor’s request for medical records?01/20/2015
Are there any specific limits on the number of office visits Medicare will pay for each year?01/20/2015
Are you required to submit therapy codes with both the GP and the GY HCPCS modifiers?01/20/2015
As a non-participating provider, why can I not charge up to the limiting charge if I accept assignment?01/20/2015
Can a chiropractor use a manual device to assist with manipulation?01/20/2015
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)?01/20/2015
Can a provider bill Medicare for missed appointments and receive reimbursement?01/20/2015
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?01/20/2015
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?01/20/2015
Can a psychologist order basic lab tests?01/20/2015
Can a psychologist order neuropsychological tests?01/20/2015
Can a travel allowance fee be charged for medically necessary specimen collection from a nursing home or homebound patient?01/20/2015
Can an Anesthesiologist Assistant (AA) append HCPCS modifier QZ to an aesthesia service?01/20/2015
Can an attending physician and an office physician both submit a claim for their services?01/20/2015
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?01/20/2015
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?01/20/2015
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?01/20/2015
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.01/20/2015
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?01/20/2015
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?'01/20/2015
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?01/20/2015
Can physical and occupational therapists both provide services to one patient at the same time?01/20/2015
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?01/20/2015
Can Psychotherapy Codes be Billed as Incident To?01/20/2015
Can the interpretation of an EKG be billed by the teaching physician if the residents are doing both the reading and interpretation?01/20/2015
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?01/20/2015
Can time be used as a basis for E/M code selection in regards to add-on psychotherapy services?01/20/2015
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?01/20/2015
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.?01/20/2015
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?01/20/2015
CMS Questions and AnswersOpen in New Window01/20/2015
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?01/20/2015
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?01/20/2015
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?01/20/2015
Do I need to send documentation for prolonged care code with each claim?01/20/2015
Do I need to submit a claim to Medicare for statutorily excluded services?01/20/2015
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?01/20/2015
Do subsequent visits need new treatment plans?01/20/2015
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?01/20/2015
Does a kidney transplant make Medicare primary from the date of the transplant?01/20/2015
Does Medicare cover hand therapy or pet therapy?01/20/2015
Does Medicare Part B cover Emend for postoperative nausea and vomiting (PONV)?01/20/2015
Does Medicare pay for unit dose medications for the COPD patients if they are in a nursing home facility?01/20/2015
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?01/20/2015
Does Medicare reimburse for ambulance transportation to and from a physician’s office?01/20/2015
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'?01/20/2015
Does Palmetto GBA cover electromagnetic wound therapy when delivered using MicroVas?01/20/2015
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6?01/20/2015
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?01/20/2015
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?01/20/2015
Generally speaking, when we say 'objective measures,' what does that mean?01/20/2015
Has your patient or their spouse experienced a loss of employment? How will this affect your Medicare payment?01/20/2015
How can I determine what codes/procedures are bundled with a certain code in the CCI edits?01/20/2015
How can I determine whether Medicare is the primary or secondary payer?01/20/2015
How can I obtain a Medigap listing?01/20/2015
How can I recognize a CERT contractor request for medical records?01/20/2015
How can Medicare Advantage plans (HMOs) affect your practice?01/20/2015
How do I change my address with Medicare since our practice is moving?01/20/2015
How do I determine which patient(s) is/are involved in an offset?01/20/2015
How do Locum Tenens arrangements work?01/20/2015
How do you determine that a problem is a new problem or if it just an exacerbation of an established problem?01/20/2015
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?01/20/2015
How does Palmetto GBA decide when to request documentation, for what services and from whom?01/20/2015
How does the CERT process work?01/20/2015
How is a claim selected and reviewed as part of the CERT process?01/20/2015
How is compliance with the CERT contractor's request for medical records beneficial to providers?01/20/2015
How is the CERT paid claims error rate determined?01/20/2015
How long does the CERT contractor have to review the medical records?01/20/2015
How often do we need to update our goals for acute and chronic conditions? If we use pain scale or ADLs, do we need to update every six months or every month?01/20/2015
How should I submit claims for bilateral ophthalmic biometry?01/20/2015
How should I submit claims for the 'off-the-shelf' form of drugs administered via implanted pump?01/20/2015
How should I submit compounded drugs administered via implanted pump?01/20/2015
How should we calculate the time for time-based psychotherapy services for the purposes of submitting claims?01/20/2015
How will we be notified of the review decision?01/20/2015
I'm submitting post-op care only by using the appropriate modifier and procedure code. I am including the number of post-op days in the days/units field and the assumed/relinquished date in the electronic documentation record, but the service is not getting paid. Why?01/20/2015
I added the 'split post-op care' modifier to the surgery code and the surgeon verified he used the modifier for 'surgical care only' and was paid for his portion of the service. Why wasn't my claim paid?01/20/2015
I am a hospitalist and all records for my services are part of the patient's hospital record. Why do Medicare contractors send me the request for medical records and not the hospital?01/20/2015
I am leasing part of a community pool to provide aquatic therapy for my patients. What place of service should I submit for this service?01/20/2015
I am with a solo physician practice and we are incorporated. Should we enter anything in Item 32a of the CMS-1500 claim form? We have a type two (organization) NPI and a type one (individual) NPI, but we have three practice locations.01/20/2015
I belong to both an individual and group practice, and use the same individual National Provider Identifier for both. When I submit claims with my individual NPI and practice address, I receive a message stating 'missing/ incomplete/ invalid group practice information.' Why is the claim not processing?01/20/2015
I have a Medicare remittance notice that shows an offset with a ‘WU’ remark code. What does the ‘WU’ indicate?01/20/2015
I have a Medicare Secondary Payer (MSP) situation involving consult codes. The primary insurer still accepts the consult codes, but Medicare does not. How should I submit my MSP claim?01/20/2015
I have a Physician Quality Reporting System (PQRS) code, formerly PQRI code, that is being returned as unprocessable with the message 'Missing/Incomplete/Invalid Charge.' Another code was returned stating 'Procedure code was invalid on the date of service.' Why won’t these codes process for 2011 dates of service?01/20/2015
I have an ambulatory surgical center (ASC) claim for brachytherapy treatment planning that was returned as unprocessable. The message states the claim was processed in accordance with ASC guidelines, but this code is on the ASC list of ancillary services that are separately payable. Why wasn’t the claim processed?01/20/2015
I have heard that Medicare payments for mental health services will change over the next few years. How will these payments be calculated and what will change?01/20/2015
I have received a denial for my submission of specialty care transport HCPCS code A0434. What could be wrong?01/20/2015
I have received a primary payment for a consultation service. My software does not allow me to change the procedure code to an evaluation and management (E/M) code that Medicare will accept. Since Medicare no longer accepts consultation codes, can I bill the patient for the co-pay from the primary insurance and not submit a claim to Medicare?01/20/2015
I keep receiving denials from my vendor/clearinghouse whenever I submit MSP claims. The remittance advice indicates error message/required element 1044. Please assist with denial code.01/20/2015
I provided split post-op care to a patient who had cataract surgery by another doctor. I added the split post-op care modifier to my visit code, but the service was not paid. Why?01/20/2015
I received a denial for my submission of a specialty care transport code. What could be wrong?01/20/2015
I received a primary payment from another insurer and a secondary payment from Medicare. Now we have too much money for that patient’s account. What should I do?01/20/2015
I received a remittance notice showing all of the Physician Quality Reporting System (PQRS) codes submitted were returned as unprocessable. The message stated 'the procedure code is inconsistent with the modifier used or a required modifier is missing.' We used HCPCS modifier GP because the PQRS codes were related to the patient’s physical therapy. Why were the PQRS codes returned?01/20/2015
I see a reason code message J1 on my remittance notice that I have never seen before. Could you explain what this message means?01/20/2015
I sent in a redetermination request for an overpayment, when will I receive a response?01/20/2015
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last updated on 2/01/2015
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