Frequently Asked Questions

Find answers to frequently asked Medicare questions below. For help with eServices, view our eServices FAQs.

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After I receive a 277CA will I receive anything else? 06/18/2018
How can I tell if I am set up for Electronic Billing? 06/18/2018
How do I restore a remit file? 06/18/2018
Is the 277CA returned for each test submission? 06/18/2018
PC-ACE Pro32 software FAQs 06/18/2018
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance? 06/18/2018
What is a Network Service Vendor? 06/18/2018
What is an approved software vendor? 06/18/2018
What provider address should I include on the EDI enrollment forms? 06/18/2018
What provider name should I include on the EDI enrollment forms? 06/18/2018
What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group? 06/18/2018
What Submitter Name should I enter on the Provider Authorization form? 06/18/2018
When is a provider authorization form required? 06/18/2018
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description? 06/18/2018
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? 06/18/2018
Am I a type/specialty that can order or refer items or services for Medicare beneficiaries? 06/04/2018
Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers? 06/04/2018
Are observation codes submitted by the hour or by the calendar date? 06/04/2018
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically? 06/04/2018
Are Your Medicare Secondary Payer (MSP) Claims Rejecting? 06/04/2018
Can a nurse practitioner perform the initial hospital visit? 06/04/2018
Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit? 06/04/2018
Can incident to occur in place of service (POS) 19 or 22 (outpatient hospital)? 06/04/2018
Can time alone be used to select an E/M code? 06/04/2018
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit? 06/04/2018
Does time need to be documented in order to submit for a hospital or nursing facility discharge service? 06/04/2018
How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal? 06/04/2018
How do I upload attachments to an Appeal request? 06/04/2018
How should I list the name of the ordering/referring provider when submitting my paper and electronic claims? 06/04/2018
If a patient had one system complaint that was documented for the review of systems (ROS) and then the provider documented: 'patient has no other complaints', is that enough to receive a complete ROS? 06/04/2018
If another provider admits a patient into Observation Care and I provide a consult, can I bill the observation care code? 06/04/2018
If I provide a statutorily excluded service am I required to have the patient sign an ABN? 06/04/2018
If we see a patient for an Annual Wellness Visit on February 14, 2017, would their next AWV eligible date before February 14, 2018? 06/04/2018
In the E/M documentation guidelines, what does 'more detail' regarding the exam mean, and what is the difference between an expanded problem-focused exam and detailed exam? 06/04/2018
Is a supervising physician's signature required for services performed by a physician assistant in the emergency department? 06/04/2018
Is Coumadin or Heparin considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk? 06/04/2018
Is it acceptable to use 'noncontributory, unremarkable or negative' when reporting past, family or social history? 06/04/2018
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical? 06/04/2018
Medicare Secondary Payer (MSP) Frequently Asked Questions 06/04/2018
Must a problem be new to the patient or new to the provider in order for it to be considered a 'new problem' when scoring diagnosis/management options for an evaluation and management (E/M) service? 06/04/2018
My claim for post-operative services billed with modifier 55 was rejected, what information was missing? 06/04/2018
My claim was denied with remittance messages 183 and N574? I submitted the name and NPI of the ordering/referring provider. What is wrong? 06/04/2018
My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong? 06/04/2018
What are CARCs and RARCs? 06/04/2018
What are the appropriate procedure codes for the first and subsequent AWVs? 06/04/2018
What is the definition of a 'new patient' when selecting an E/M CPT code? 06/04/2018
What place of service (POS) do I use when reading a test from a remote location? 06/04/2018
What shall I do if I don't have an enrollment record in Medicare? 06/04/2018
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? 06/04/2018
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)? 06/04/2018
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? 06/04/2018
Where can I find information about the New Medicare Cards project? Open in New Window06/04/2018
Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code? 06/04/2018
Who are the CERT contractors? 06/04/2018
Why was my office visit denied when billed on the same surgery date of service? 06/04/2018
How can I check the status of my first level appeal? 05/10/2018
My remittance notice shows a dollar amount withheld. How to I determine which patient that amount is being withheld for? 05/10/2018
The Palmetto GBA Provider Enrollment Application Status tool lists my application status as 'Received.' What does that mean and at what points will the status tool be updated? 05/10/2018
Why are my claims rejecting for MSP with Reason Code CO-16 and remarks codes MA04 and MA130 and what do I need to do? 05/10/2018
Who are the medical directors for Palmetto GBA? 04/06/2018
If our office incorrectly reconstituted Herceptin (Trastuzumab) using sterile water instead of bacteriostatic water, and we are unable to store and use the rest of the vial, can our facility bill for the wasted drug and the administered amount? 04/04/2018
Incident To and Split/Shared Services Frequently Asked Questions 04/04/2018
Is AmnioFix covered by Medicare? 04/04/2018
Is the immunosuppressive therapy included in the 90-day global period for kidney transplants? 04/04/2018
Locum Tenens Frequently Asked Questions 04/04/2018
Medicaid is denying a claim crossed over from Medicare stating it is missing the provider's taxonomy number. The claim included the taxonomy number so why was it removed when the claim crossed over to Medicaid? 04/04/2018
My claim was returned with the message 'the procedure code is inconsistent with the modifier used or a required modifier is missing.' I submitted two modifiers, and they should both be valid for the procedure code. Why was my claim rejected? 04/04/2018
We are receiving a bundling denial even though we submitted a CPT modifier to indicate the service was distinct or independent from the other non-E/M services performed on the same day. Why is the service being denied? 04/04/2018
What actions are being taken to assist providers who do not have a one-to-one match with their PTANs and NPI? 04/04/2018
What are the documentation requirements for hospital visits in a teaching facility? 04/04/2018
What are the guidelines for placement of cardiac pacemakers and defibrillators? 04/04/2018
What are the Medicare requirements for shared services? 04/04/2018
What does it mean to be a participating provider? 04/04/2018
What is the Qualified Medicare Beneficiary (QMB) program? 04/04/2018
What should I do if I receive two primary payments? 04/04/2018
What subsequent hospital visits guidelines/criteria must be met in order for an interval history to be considered problem focused, expanded problem focused or detailed? 04/04/2018
What type of documentation is needed to support an assistant surgeon's claim? 04/04/2018
When a patient is admitted to observation status must the place of service and codes billed by the Part B provider always match what the hospital bills on the UB claim form? 04/04/2018
When an LCD is retired, does this mean that the information in the LCD is obsolete? 04/04/2018
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? 04/04/2018
When is a beneficiary eligible for the Annual Wellness Visit? 04/04/2018
When using bilateral procedure modifier, do I always submit '1' in the units field? 04/04/2018
When using the Clock Draw test (CDT) to assess the patient's cognitive function as part of the Annual Wellness Visit, do we need to scan the actual paper CDT into the patient's medical record? 04/04/2018
Why are some of our claims denying with message B9 (patient enrolled in hospice)? The services are unrelated to the patient's hospice diagnosis. 04/04/2018
Why can't we get claim status, entitlement or deductible information from a customer service representative? 04/04/2018
Why did Medicare deny my claim indicating that a Skilled Nursing Facility (SNF) is responsible for payment of my service? 04/04/2018
Why isn't a procedure code listed on the Medicare Physician Fee Schedule (MPFS)? 04/04/2018
What does forwarding balance mean on my remittance notice? 03/22/2018
PC-ACE Pro32 software FAQs 03/20/2018
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)? 03/02/2018
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service? 03/02/2018
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)? 03/02/2018
Can a provider bill Medicare for missed appointments and receive reimbursement? 03/02/2018
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? 03/02/2018
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? 03/02/2018
Can a psychologist order basic lab tests? 03/02/2018
Can a service be billed as 'incident to' if the auxiliary staff performing the service, where there is no face-to-face encounter with the billing provider, changes a patient's treatment plan based on protocol or the results of laboratory tests? 03/02/2018
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable? 03/02/2018
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code? 03/02/2018
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service? 03/02/2018
Can we combine the body areas and organ system to determine the complexity of the examination? The CMS 1995 E/M documentation guidelines use the words 'and' and 'or' on page 10 when referencing how to differentiate the level of complexity of the examination portion of an E/M service. 03/02/2018
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? 03/02/2018
CMS Questions and Answers Open in New Window03/02/2018
Deductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB) 03/02/2018
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information? 03/02/2018
Do you have a coding question? 03/02/2018
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'? 03/02/2018
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6? 03/02/2018
How can I determine what codes/procedures are bundled with a certain code in the CCI edits? 03/02/2018
How can I obtain a Medigap listing? 03/02/2018
How can Medicare Advantage plans (HMOs) affect your practice? 03/02/2018
How do I change my address with Medicare since our practice is moving? 03/02/2018
How do Locum Tenens arrangements work? 03/02/2018
How to Determine an Independent Diagnostic Testing Facility (IDTF) 03/02/2018
I have a Medicare remittance notice that shows an offset with a 'WU' remark code. What does the 'WU' indicate? 03/02/2018
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? 03/02/2018
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? 03/02/2018
I see a reason code message J1 on my remittance notice that I have never seen before. Could you explain what this message means? 03/02/2018
I submitted numerous claims for fundus photography with the bilateral procedure modifier to indicate that the procedure was performed on both eyes, but the services were rejected. Why? 03/02/2018
If a patient presents to the office for an injection, infusion or venipuncture, would it be acceptable to submit an office or other outpatient visit CPT code? 03/02/2018
   

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