Frequently Asked Questions


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





Frequently Asked Questions Articles


My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong?What shall I do if I don't have an enrollment record in Medicare?Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?My claim was denied with remittance messages 183 and N574. I submitted the name and NPI of the ordering/referring provider. What is wrong?If I provide a statutorily excluded service am I required to have the patient sign an ABN?Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers?Who are the Comprehensive Error Rate Testing (CERT) contractors?How do I upload attachments to an appeal request?What are CARCs and RARCs?How should I list the name of the ordering/referring provider when submitting my paper and electronic claims?Are observation codes submitted by the hour or by the calendar date?What is the definition of a 'new patient' when selecting an E/M CPT code?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?Does time need to be documented in order to submit for a hospital or nursing facility discharge service?Can "incident to" occur in place of service (POS) 19 or 22 (outpatient hospital)?Is it acceptable to use 'noncontributory, unremarkable or negative' when reporting past, family or social history?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)?What specific information can ancillary staff (e.g., RN, LPN, CNA) document during an evaluation and management (E/M) encounter?How do I make text larger to make it easier to read?What place of service (POS) do I use when reading a test from a remote location?My claim for post-operative services billed with a modifier for 'Postoperative Management Only' was rejected. What information was missing?Where can I find information about the new Medicare cards project?Is Coumadin or Heparin considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk?Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code?Quarterly Frequently Asked Questions (FAQs): April 2020Jurisdictions J and M Part B Frequently Asked Questions: October 2020Jurisdictions J and M Part B Frequently Asked Questions: July 2020Jurisdiction J and M Part B Quarterly Frequently Asked Questions: January 2021Is a supervising physician's signature required for services performed by a physician assistant in the emergency department?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?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?I have a Medicare remittance notice that shows an offset with a 'WU' remark code. What does the 'WU' indicate?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?How do Locum Tenens, now referred to as Fee-For-Time Compensation Arrangements, work?How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal?If another provider admits a patient into Observation Care and I provide a consult, can I bill the observation care code?I see a reason code message J1 on my remittance notice that I have never seen before. Could you explain what this message means?How can I obtain a Medigap listing?How can I check the status of my first level appeal?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?How can Medicare Advantage plans (HMOs) affect your practice?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)?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.Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?Can a psychologist order basic lab tests?Can a provider bill Medicare for missed appointments and receive reimbursement?Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?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?'Incident To' and Split/Shared Services Frequently Asked QuestionsDoes Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity?'Do you have a coding question?Locum Tenens Frequently Asked QuestionsDeductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB)Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?Why can't we get claim status, entitlement or deductible information from a customer service representative?What are the ordering and referring edits?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?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?What are the Medicare requirements for shared services?Why did my patient's MBI change and which MBI do we use?What actions are being taken to assist providers who do not have a one-to-one match with their PTANs and NPI?Why did Medicare deny my claim indicating that a Skilled Nursing Facility (SNF) is responsible for payment of my service?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?Why are some of our claims denying with message B9 (patient enrolled in hospice)? The services are unrelated to the patient's hospice diagnosis.When an LCD is retired, does this mean that the information in the LCD is obsolete?What type of documentation is needed to support an assistant surgeon's claim?Why isn't a procedure code listed on the Medicare Physician Fee Schedule (MPFS)?What does it mean to be a participating provider?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?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?What does 'forwarding balance' mean on my remittance notice?Why must providers use available self-serve tools for certain actions instead of speaking with a Palmetto GBA customer service representative?Where can I locate a listing of the Medicare provider specialty codes?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?’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?Jurisdictions J and M Part B Quarterly FAQ: April 2021What are the guidelines for placement of cardiac pacemakers and defibrillators?Are Your Medicare Secondary Payer (MSP) Claims Rejecting?Why are my claims rejecting Medicare Secondary Payer (MSP) with Reason Code CO-16 and remarks codes MA04 and MA130 and what do I need to do?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?Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?How do I identify EFT transactions from Palmetto GBA on my bank statement?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?What should I do if I receive two primary payments?Who are the medical directors for Palmetto GBA?Medicare Secondary Payer (MSP) Educational Series Questions and AnswersHow long does a Public Health Emergency (PHE) declaration last?Can time alone be used to select an E/M code?