Frequently Asked Questions

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Quarterly Frequently Asked Questions (FAQs): November 2019 11/20/2019
Where can I locate a listing of the Medicare provider specialty codes? 11/06/2019
After I receive a 277CA will I receive anything else? 09/19/2019
How can I tell if I am set up for Electronic Billing? 09/19/2019
How do I restore a remit file? 09/19/2019
Is the 277CA returned for each test submission? 09/19/2019
PC-ACE Pro32 software FAQs 09/19/2019
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance? 09/19/2019
What is a Network Service Vendor? 09/19/2019
What is an approved software vendor? 09/19/2019
What provider address should I include on the EDI enrollment forms? 09/19/2019
What provider name should I include on the EDI enrollment forms? 09/19/2019
What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group? 09/19/2019
What Submitter Name should I enter on the Provider Authorization form? 09/19/2019
When is a provider authorization form required? 09/19/2019
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description? 09/19/2019
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? 09/19/2019
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)? 09/03/2019
Am I a type/specialty that can order or refer items or services for Medicare beneficiaries? 09/03/2019
Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers? 09/03/2019
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service? 09/03/2019
Are observation codes submitted by the hour or by the calendar date? 09/03/2019
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically? 09/03/2019
Are Your Medicare Secondary Payer (MSP) Claims Rejecting? 09/03/2019
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)? 09/03/2019
Can a nurse practitioner perform the initial hospital visit? 09/03/2019
Can a provider bill Medicare for missed appointments and receive reimbursement? 09/03/2019
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? 09/03/2019
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? 09/03/2019
Can a psychologist order basic lab tests? 09/03/2019
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? 09/03/2019
Can clarification be provided regarding the statement found in the MLN Matters Number: SE1010 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?" 09/03/2019
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable? 09/03/2019
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code? 09/03/2019
Can incident to occur in place of service (POS) 19 or 22 (outpatient hospital)? 09/03/2019
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service? 09/03/2019
Can time alone be used to select an E/M code? 09/03/2019
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. 09/03/2019
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? 09/03/2019
CMS Questions and Answers Open in New Window09/03/2019
Deductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB) 09/03/2019
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information? 09/03/2019
Do you have a coding question? 09/03/2019
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit? 09/03/2019
Does Medicare cover preventive mastectomies when testing indicates a patient is at risk for developing breast cancer or when the patient has a genetic mutation? 09/03/2019
Does Palmetto GBA consider Coumadin or Heparin a "drug requiring intensive monitoring for toxicity"? 09/03/2019
Does time need to be documented in order to submit for a hospital or nursing facility discharge service? 09/03/2019
How can I check the status of my first level appeal? 09/03/2019
How can I determine what codes/procedures are bundled with a certain code in the CCI edits? 09/03/2019
How can I obtain a Medigap listing? 09/03/2019
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