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Jurisdiction 11 Part B
Frequently Asked Questions



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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?04/15/2014
Appeals: What happens to an incomplete redetermination request?04/15/2014
Can a single visit be counted as both the IPPE and an AWV?04/15/2014
Can other medical services be performed at the same time as an AWV? If so, how are they coded?04/15/2014
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.?04/15/2014
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?04/15/2014
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?04/15/2014
Does Medicare reimburse for ambulance transportation to and from a physician’s office?04/15/2014
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?04/15/2014
I have received a denial for my submission of specialty care transport HCPCS code A0434. What could be wrong?04/15/2014
I received a denial for my submission of a specialty care transport code. What could be wrong?04/15/2014
If a patient is being transported to a wound care center located within a hospital or on hospital grounds, which destination modifier would be used when filing the claim?04/15/2014
If our claim denies for a Medically Unlikely Edit (MUE), do we have to submit a first level appeal (Redetermination) or can we submit a Clerical Error Reopening Request form instead?04/15/2014
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?04/15/2014
Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?04/15/2014
May we fax documentation in response to Additional Documentation Request (ADR) letters using the fax attachments for electronic claims?04/15/2014
My claim for 'external circulation assist: each additional 24 hours,' was denied stating an add-on code cannot be submitted by itself (it is on the same claim as the service for 'external circulation assist: initial 24 hours,')?04/15/2014
My paper claim was rejected with message N34, incorrect claim form/format for this service. What is wrong with my claim form?04/15/2014
Some nursing facilities provide all three types of services (skilled care, non-skilled care and residential care) at the same facility. How do we verify what area of that facility the patient resides in so we know what modifier to use when filing our claims?04/15/2014
The CO-97 denial is 'Patient was an inpatient on the date of service'. Some hospital facilities do not understand why we bill them for our transports in order for us to get paid for our services. Is the hospital responsible for the payment of the transports while the patient is an inpatient?04/15/2014
What are the appropriate procedure codes for the first and subsequent AWVs?04/15/2014
What are the guidelines for placement of cardiac pacemakers and defibrillators?04/15/2014
What documentation is required for transtelephonic monitoring?04/15/2014
What HCPCS modifier should be used when transporting patients to and from satellite offices/urgent care centers owned by a large hospital? Since these are satellite offices of the hospital, why wouldn’t they be considered the 'hospital' and be filed with HCPCS modifier 'H?'04/15/2014
When a hospital requests a 'hospital to hospital' transport in a rapid/urgent manner, without lights and sirens, would this type of transport be considered emergent? Or, is this transport based solely on the patient’s condition at the time of transport?04/15/2014
When is a beneficiary eligible for the Annual Wellness Visit?04/15/2014
Where can I find information on telephone pacemaker analysis?04/15/2014
Revalidation Initiative: Frequently Asked Questions (FAQs)04/11/2014
Why did I recently receive a revalidation request letter?04/11/2014
5010 FAQ: Is there a way to submit claims not using the dial-up system, e.g. FTP, Web-based file transfer, etc.?04/10/2014
5010 FAQs on PC-ACE Pro32 software03/19/2014
5010 FAQ: After I receive a 277CA will I receive anything else?03/19/2014
5010 FAQ: Are there 5010 MSP examples available to view?03/19/2014
5010 FAQ: Can we use our submitter ID that is currently used to send production claims or do we need to use our vendor ID?03/19/2014
5010 FAQ: Do you have any recommendations on software specifically for outpatient physical therapy?03/19/2014
5010 FAQ: Do you know if the physical address requirement is just for Medicare or all insurance?03/19/2014
5010 FAQ: 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?03/19/2014
5010 FAQ: How do we distinguish test from production submissions?03/19/2014
5010 FAQ: I heard that 5010 requires a physical address in box 33 and P.O. Boxes are no longer accepted. Is this true?03/19/2014
5010 FAQ: If I am using a clearinghouse and they are not on the approved vendor list, what are my options? I have spoken to them and they state they are in testing. What else can I do to prepare?03/19/2014
5010 FAQ: If we pass testing as a submitter, will we be able to submit claims for all our providers without them testing as well?03/19/2014
5010 FAQ: Is the 277CA returned for each test submission?03/19/2014
5010 FAQ: Is the taxonomy code required in the 2000 loop for 5010?03/19/2014
5010 FAQ: Must we send a 270 v5010 to receive the 271 v5010?03/19/2014
5010 FAQ: Once a software vendor is an approved submitter, will the providers who use that software have to also test? If not, what will the procedure be to move providers of an approved vendor into 5010 production?03/19/2014
5010 FAQ: We are a provider and have our production Submitter ID. Our vendor states they don’t have a Vendor ID. Would they be responsible to get one with EDI?03/19/2014
5010 FAQ: We called Palmetto GBA EDI and were advised that the vendor was responsible for the testing and that we as providers may test but only after the vendor completed their testing?03/19/2014
5010 FAQ: What if we do not receive the 999 and 277CA consistency?03/19/2014
5010 FAQ: What is an approved software vendor?03/19/2014
5010 FAQ: What is the most current version (date) of the 837 implementation guides?03/19/2014
5010 FAQ: Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?03/19/2014
5010 FAQ: Where is the 5010 certified vendor list on your website?03/19/2014
5010 FAQ: Will one test file allow me to move to PROD? And does the file require 25 claims?03/19/2014
5010 FAQ: Will small providers still be able to submit paper claims? Will they still continue to use the existing CMS-1500 form?03/19/2014
5010 FAQ: 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?03/19/2014
Can I submit ICD10 test files with my existing Submitter ID or do I have to obtain a new one?03/19/2014
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?03/19/2014
If I am uncertain as to whether Medicare or the CERT contractor can read my doctor's signature may I voluntarily submit a signature log when asked to provide documentation?03/14/2014
Is AmnioFix covered by Medicare?03/14/2014
JW HCPCS Modifier: Frequently Asked Questions03/14/2014
My remittance advice (RA) contained code LE - Levy. What does this mean?03/14/2014
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?03/14/2014
I was late to the Webinar and missed information presented at the beginning. Is there a way for me to watch the session in its entirety later?03/12/2014
What does forwarding balance mean on my remittance notice?03/11/2014
What are the documentation requirements for billing observation or inpatient hospital care services (including admission and discharge services)?03/10/2014
What causes a claim to be Unprocessable/Rejected?03/10/2014
What date of service would I use for an Evaluation & Management (E/M) visit that begins on one day and ends on the next?03/10/2014
What is the definition of a 'new patient' when selecting an evaluation and management (E/M) CPT code?03/10/2014
What is the difference between the 1995 and 1997 Evaluation and Management (E/M) Guidelines?03/10/2014
What place of service (POS) do I use when reading a test from a remote location?03/10/2014
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?03/10/2014
When determining the level of complexity for a 1995 Examination can you combine the Body Areas and Organ Systems?03/10/2014
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?03/10/2014
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)?03/10/2014
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?03/10/2014
Why am I not eligible for the Primary Care Incentive Program (PCIP) payment?03/10/2014
Why did Medicare change the CLIA number on my claim?03/10/2014
Why is an office visit denied when the patient has seen another provider of the same specialty on the same date of service (the first provider visit was unknown to us)?03/10/2014
Why was my first Primary Care Incentive Program (PCIP) payment so low?03/10/2014
Will ICD-10 testing be available for providers that use Palmetto GBA's online service rather than going through a clearinghouse?03/10/2014
How can I search local coverage determinations (LCD) for a specific CPT/HCPCS code?03/07/2014
What is Twitter?03/06/2014
Who are the medical directors for J11?03/06/2014
Why do the links in my email listserv not work?03/06/2014
Why was my redetermination request denied when I submitted a letter showing my patient was no longer incarcerated at the time of my service?03/06/2014
Will I be able to obtain a copy of the presentation for the Webcast I attended?03/06/2014
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?03/06/2014
My patient is no longer incarcerated, but the records have not been updated. Who do I need to contact to have the records updated?03/05/2014
New Therapy Cap Process: Frequently Asked Questions03/05/2014
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?03/05/2014
What are the differences between using Twitter to receive listserv messages and using email?03/05/2014
What do I tweet? What should I say?03/05/2014
What do these Twitter terms mean?03/05/2014
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)?03/04/2014
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?03/04/2014
Am I an Independent Diagnostic Testing Facility (IDTF)?03/04/2014
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?03/04/2014
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?03/04/2014
Are health care providers required to comply with the CERT contractor’s request for medical records?03/04/2014
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last updated on 4/01/2014
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