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Published Date:12/01/2016

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

Frequently Asked Questions

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After I receive a 277CA will I receive anything else?	03/22/2021
How can I tell if I am set up for Electronic Billing?	03/22/2021
How do I restore a remit file?	03/22/2021
Is the 277CA returned for each test submission?	03/22/2021
PC-ACE Pro32 software FAQs	03/22/2021
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?	03/22/2021
What is a Network Service Vendor?	03/22/2021
What is an approved software vendor?	03/22/2021
What provider address should I include on the EDI enrollment forms?	03/22/2021
What provider name should I include on the EDI enrollment forms?	03/22/2021
What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?	03/22/2021
What Submitter Name should I enter on the Provider Authorization form?	03/22/2021
When is a provider authorization form required?	03/22/2021
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?	03/22/2021
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?	03/22/2021
Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers?	03/01/2021
Are observation codes submitted by the hour or by the calendar date?	03/01/2021
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?	03/01/2021
Are Your Medicare Secondary Payer (MSP) Claims Rejecting?	03/01/2021
Can time alone be used to select an E/M code?	03/01/2021
Can "incident to" occur in place of service (POS) 19 or 22 (outpatient hospital)?	03/01/2021
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?	03/01/2021
Does time need to be documented in order to submit for a hospital or nursing facility discharge service?	03/01/2021
How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal?	03/01/2021
How do I upload attachments to an appeal request?	03/01/2021
How should I list the name of the ordering/referring provider when submitting my paper and electronic claims?	03/01/2021
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?	03/01/2021
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?	03/01/2021
If another provider admits a patient into Observation Care and I provide a consult, can I bill the observation care code?	03/01/2021
If I provide a statutorily excluded service am I required to have the patient sign an ABN?	03/01/2021
Is a supervising physician's signature required for services performed by a physician assistant in the emergency department?	03/01/2021
Is Coumadin or Heparin considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk?	03/01/2021
Is it acceptable to use 'noncontributory, unremarkable or negative' when reporting past, family or social history?	03/01/2021
My claim for post-operative services billed with a modifier for 'Postoperative Management Only' was rejected. What information was missing?	03/01/2021
My claim was denied with remittance messages 183 and N574. I submitted the name and NPI of the ordering/referring provider. What is wrong?	03/01/2021
My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong?	03/01/2021
What are CARCs and RARCs?	03/01/2021
What is the definition of a 'new patient' when selecting an E/M CPT code?	03/01/2021
What shall I do if I don't have an enrollment record in Medicare?	03/01/2021
What specific information can ancillary staff (e.g., RN, LPN, CNA) document during an evaluation and management (E/M) encounter?	03/01/2021
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 HPI (e.g., patient had severe dementia)?	03/01/2021
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?	03/01/2021
Where can I find information about the new Medicare cards project?	03/01/2021
Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code?	03/01/2021
Who are the Comprehensive Error Rate Testing (CERT) contractors?	03/01/2021
Why do the links in my email listserv not work?	03/01/2021
Jurisdiction J and M Part B Quarterly Frequently Asked Questions: January 2021	01/25/2021
Who are the medical directors for Palmetto GBA?	01/21/2021
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?	12/30/2020
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?	12/30/2020
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?	12/30/2020
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?	12/30/2020
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.	12/30/2020
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity?'	12/30/2020
How can I check the status of my first level appeal?	12/30/2020
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?	12/30/2020
Revised, page 8, ‘The split/shared rules applying to E/M services remain in effect, including those cases where services would previously have been reported by CPT consultation codes?’	12/30/2020
What are the guidelines for placement of cardiac pacemakers and defibrillators?	12/30/2020
What are the Medicare requirements for shared services?	12/30/2020
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?	12/30/2020
Why can't we get claim status, entitlement or deductible information from a customer service representative?	12/30/2020
"Incident To" and Split/Shared Services Frequently Asked Questions	12/30/2020
Locum Tenens Frequently Asked Questions	12/11/2020
How can Medicare Advantage plans (HMOs) affect your practice?	12/09/2020
How do Locum Tenens, now referred to as Fee-For-Time Compensation Arrangements, work?	12/09/2020
When I call the Interactive Voice Response (IVR) system and select option #2 (Financials), then option #1 (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?	12/09/2020
Where there is no face-to-face encounter with the billing provider, can a service be billed as "incident to" if the auxiliary staff performing the service changes a patient's treatment plan based on protocol or the results of laboratory tests?	12/09/2020
Why must providers use available self-serve tools for certain actions instead of speaking with a Palmetto GBA customer service representative?	12/09/2020
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)?	12/07/2020
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?	12/01/2020
Can a provider bill Medicare for missed appointments and receive reimbursement?	12/01/2020
Can a psychologist order basic lab tests?	12/01/2020
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?	12/01/2020
Deductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB)	12/01/2020
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?	12/01/2020
Do you have a coding question?	12/01/2020
How can I obtain a Medigap listing?	12/01/2020
I have a Medicare remittance notice that shows an offset with a 'WU' remark code. What does the 'WU' indicate?	12/01/2020
I see a reason code message J1 on my remittance notice that I have never seen before. Could you explain what this message means?	12/01/2020
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?	12/01/2020
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?	12/01/2020
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?	12/01/2020
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?	12/01/2020
What actions are being taken to assist providers who do not have a one-to-one match with their PTANs and NPI?	12/01/2020
What does 'forwarding balance' mean on my remittance notice?	12/01/2020
What does it mean to be a participating provider?	12/01/2020
What place of service (POS) do I use when reading a test from a remote location?	12/01/2020
What should I do if I receive two primary payments?	12/01/2020
What type of documentation is needed to support an assistant surgeon's claim?	12/01/2020
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?	12/01/2020
When an LCD is retired, does this mean that the information in the LCD is obsolete?	12/01/2020
Where can I locate a listing of the Medicare provider specialty codes?	12/01/2020
Why are my claims rejecting Medicare Secondary Payer (MSP) with Reason Code CO-16 and remark codes MA04 and MA130, and what do I need to do?	12/01/2020
Why are some of our claims denying with message B9 (patient enrolled in hospice)? The services are unrelated to the patient's hospice diagnosis.	12/01/2020
Why did Medicare deny my claim indicating that a Skilled Nursing Facility (SNF) is responsible for payment of my service?	12/01/2020
Why isn't a procedure code listed on the Medicare Physician Fee Schedule (MPFS)?	12/01/2020
Jurisdictions J and M Part B Frequently Asked Questions: October 2020	10/26/2020
Jurisdictions J and M Part B Frequently Asked Questions: July 2020	08/06/2020
Quarterly Frequently Asked Questions (FAQs): April 2020	04/24/2020