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Jurisdiction 11 Part B
Frequently Asked Questions

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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?07/15/2014
If anesthesia begins at 11 p.m. and ends at 12:15 a.m. the next day, what date of service should be used when submitting the claim?07/15/2014
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?07/15/2014
If I provide a statutorily excluded service am I required to have the patient sign an ABN?07/15/2014
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?07/15/2014
Is a chiropractor required to submit claims for non-covered services, such as an office visit? How do I know if the patient's secondary insurance will consider the service if Medicare does not cover it?07/15/2014
Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?07/15/2014
May we appeal the CERT contractor's decision?07/15/2014
May we fax documentation in response to Additional Documentation Request (ADR) letters using the fax attachments for electronic claims?07/15/2014
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,')?07/15/2014
Provider Enrollment Application: Frequently Asked Questions07/15/2014
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?07/15/2014
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?07/15/2014
What are the guidelines for placement of cardiac pacemakers and defibrillators?07/15/2014
What are the requirements for returning medical documentation requests to CERT Documentation Contractor?07/15/2014
What does it mean to be a participating provider?07/15/2014
What is Comprehensive Error Rate Testing?07/15/2014
What is the CERT provider compliance error rate?07/15/2014
What measureable goals are acceptable?07/15/2014
What should we do if we receive multiple requests for medical records from the CERT contractor?07/15/2014
What will happen to my claim if submitted with the patient’s incorrect date of birth?07/15/2014
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?07/15/2014
When I call the Interactive Voice Response (IVR) system and select option #2 'Payment Information' then option #1 for 'Payment Floor Information', the IVR states that I have 256 claims on the payment floor for $10,652.10. Where do those numbers come from and what is the payment floor?07/15/2014
When I receive a request for medical records from the CERT contractor for services provided to an inpatient, outpatient, or nursing home patient, may I just forward the request to the facility for them to fulfill the request and submit the records?07/15/2014
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last updated on 7/01/2014
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