Frequently Asked Questions

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Jurisdictions J and M Part B Frequently Asked Questions: July 2020 08/06/2020
Who are the medical directors for Palmetto GBA? 08/05/2020
Why do the links in my email listserv not work? 07/23/2020
Deductible and Coinsurance Write-off Amounts for Qualified Medicare Beneficiaries (QMB) 06/30/2020
Can incident to occur in place of service (POS) 19 or 22 (outpatient hospital)? 06/26/2020
Can time alone be used to select an E/M code? 06/26/2020
Does time need to be documented in order to submit for a hospital or nursing facility discharge service? 06/26/2020
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? 06/26/2020
If another provider admits a patient into Observation Care and I provide a consult, can I bill the observation care code? 06/26/2020
Is Coumadin or Heparin considered a "drug requiring intensive monitoring for toxicity" under the Table of Risk? 06/26/2020
Is it acceptable to use "noncontributory, unremarkable or negative" when reporting past, family or social history? 06/26/2020
What specific information can ancillary staff (e.g., RN, LPN, CNA) document during an evaluation and management (E/M) encounter? 06/26/2020
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)? 06/26/2020
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? 06/26/2020
Why was my office visit denied when billed on the same surgery date of service? 06/26/2020
After I receive a 277CA will I receive anything else? 06/09/2020
How can I tell if I am set up for Electronic Billing? 06/09/2020
How do I restore a remit file? 06/09/2020
Is the 277CA returned for each test submission? 06/09/2020
PC-ACE Pro32 software FAQs 06/09/2020
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance? 06/09/2020
What is a Network Service Vendor? 06/09/2020
What is an approved software vendor? 06/09/2020
What provider address should I include on the EDI enrollment forms? 06/09/2020
What provider name should I include on the EDI enrollment forms? 06/09/2020
What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group? 06/09/2020
What Submitter Name should I enter on the Provider Authorization form? 06/09/2020
When is a provider authorization form required? 06/09/2020
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description? 06/09/2020
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? 06/09/2020
'Incident To' and Split/Shared Services Frequently Asked Questions 06/02/2020
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)? 06/02/2020
Am I a type/specialty that can order or refer items or services for Medicare beneficiaries? 06/02/2020
Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers? 06/02/2020
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service? 06/02/2020
Are observation codes submitted by the hour or by the calendar date? 06/02/2020
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically? 06/02/2020
Are Your Medicare Secondary Payer (MSP) Claims Rejecting? 06/02/2020
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)? 06/02/2020
Can a nurse practitioner perform the initial hospital visit? 06/02/2020
Can a provider bill Medicare for missed appointments and receive reimbursement? 06/02/2020
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? 06/02/2020
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? 06/02/2020
Can a psychologist order basic lab tests? 06/02/2020
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? 06/02/2020
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable? 06/02/2020
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code? 06/02/2020
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service? 06/02/2020
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. 06/02/2020
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? 06/02/2020
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information? 06/02/2020
Do you have a coding question? 06/02/2020
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit? 06/02/2020
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? 06/02/2020
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity?' 06/02/2020
How can I check the status of my first level appeal? 06/02/2020
How can I determine what codes/procedures are bundled with a certain code in the CCI edits? 06/02/2020
How can I obtain a Medigap listing? 06/02/2020
How can Medicare Advantage plans (HMOs) affect your practice? 06/02/2020
How do I determine an independent diagnostic testing facility (IDTF)? 06/02/2020
How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal? 06/02/2020
How do I upload attachments to an Appeal request? 06/02/2020
How do Locum Tenens arrangements work? 06/02/2020
How should I list the name of the ordering/referring provider when submitting my paper and electronic claims? 06/02/2020
I have a Medicare remittance notice that shows an offset with a 'WU' remark code. What does the 'WU' indicate? 06/02/2020
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? 06/02/2020
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? 06/02/2020
I see a reason code message J1 on my remittance notice that I have never seen before. Could you explain what this message means? 06/02/2020
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? 06/02/2020
If I provide a statutorily excluded service am I required to have the patient sign an ABN? 06/02/2020
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? 06/02/2020
Is a supervising physician's signature required for services performed by a physician assistant in the emergency department? 06/02/2020
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical? 06/02/2020
Is the immunosuppressive therapy included in the 90-day global period for kidney transplants? 06/02/2020
Locum Tenens Frequently Asked Questions 06/02/2020
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? 06/02/2020
Medicare Secondary Payer (MSP) Frequently Asked Questions 06/02/2020
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? 06/02/2020
My claim for post-operative services billed with a modifier for "Postoperative Management Only" was rejected. What information was missing? 06/02/2020
My claim was denied with remittance messages 183 and N574. I submitted the name and NPI of the ordering/referring provider. What is wrong? 06/02/2020
My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong? 06/02/2020
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? 06/02/2020
My remittance notice shows a dollar amount withheld. How to I determine which patient that amount is being withheld for? 06/02/2020
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?’ 06/02/2020
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? 06/02/2020
What actions are being taken to assist providers who do not have a one-to-one match with their PTANs and NPI? 06/02/2020
What are CARCs and RARCs? 06/02/2020
What are the appropriate procedure codes for the first and subsequent AWVs? 06/02/2020
What are the documentation requirements for hospital visits in a teaching facility? 06/02/2020
What are the guidelines for placement of cardiac pacemakers and defibrillators? 06/02/2020
What are the Medicare requirements for shared services? 06/02/2020
What does 'forwarding balance' mean on my remittance notice? 06/02/2020
What does it mean to be a participating provider? 06/02/2020
What is the definition of a "new patient" when selecting an E/M CPT code? 06/02/2020
What place of service (POS) do I use when reading a test from a remote location? 06/02/2020
What shall I do if I don't have an enrollment record in Medicare? 06/02/2020
What should I do if I receive two primary payments? 06/02/2020
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? 06/02/2020
What type of documentation is needed to support an assistant surgeon's claim? 06/02/2020
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? 06/02/2020
When an LCD is retired, does this mean that the information in the LCD is obsolete? 06/02/2020
When I call the Interactive Voice Response (IVR) system and select option #2 (Payment Information), 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? 06/02/2020
When is a beneficiary eligible for the Annual Wellness Visit? 06/02/2020
When using bilateral procedure modifier, do I always submit '1' in the Units field? 06/02/2020
When using the clock-drawing 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? 06/02/2020
Where can I find information about the New Medicare Cards project? Open in New Window06/02/2020
Where can I locate a listing of the Medicare provider specialty codes? 06/02/2020
Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code? 06/02/2020
Who are the Comprehensive Error Rate Testing (CERT) contractors? 06/02/2020
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? 06/02/2020
Why are some of our claims denying with message B9 (patient enrolled in hospice)? The services are unrelated to the patient's hospice diagnosis. 06/02/2020
Why can't we get claim status, entitlement or deductible information from a customer service representative? 06/02/2020
Why did Medicare deny my claim indicating that a Skilled Nursing Facility (SNF) is responsible for payment of my service? 06/02/2020
Why isn't a procedure code listed on the Medicare Physician Fee Schedule (MPFS)? 06/02/2020
Why must providers use available self-serve tools for certain actions instead of speaking with a Palmetto GBA customer service representative? 06/02/2020
Quarterly Frequently Asked Questions (FAQs): April 2020 04/24/2020
Quarterly Frequently Asked Questions (FAQs): January 2020 02/03/2020
Quarterly Frequently Asked Questions (FAQs): November 2019 12/02/2019
Quarterly Frequently Asked Questions (FAQs): June 2019 05/27/2019
Quarterly Frequently Asked Questions (FAQs): March 2019 03/28/2019
Quarterly Frequently Asked Questions (FAQs): November 2018 11/20/2018
Quarterly Frequently Asked Questions (FAQs): August 2018 08/13/2018
   

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