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A Group Health Plan (GHP) has recouped a primary payment on a claim processed over a year old indicating Medicare should have been primary. Will Medicare override timely filing rules and process an adjustment claim? 01/24/2020
A Local Coverage Determination (LCD) is denoted as superseded on the CMS website. Please provide me with the advisory, notice or policy that gives the verbiage which supersedes this LCD. It is rumored that the supporting diagnosis codes have been revised, but there is no record I have found to verify this. 01/23/2020
A PIP hospital provider received a demand letter requesting payment on a RAC DRG change that resulted in an overpayment. If the provider issues a check to Palmetto GBA and the claim is also adjusted in the FISS system, will we not be repaying the amount twice, both in the check issued and then upon cost report settlement? 01/23/2020
Are hospital labs that file institutional claims exempt from the MolDx Program requirements? 01/23/2020
Can a provider bill a skilled nursing facility (SNF) or swing bed (SB) claim if the patient does not have a qualifying hospital stay? 01/23/2020
Claims Overlap FAQs 01/23/2020
For the new A/B Rebilling process, what should be billed on the 13x type of bill (TOB) versus on the 12 TOB? 01/23/2020
How do I bill my claims when a patient revokes or elects hospice coverage during his/her inpatient stay? 01/23/2020
How do I enter three modifiers in Direct Data Entry (DDE)? There is no room to report the third modifier on Page 2 when keying a claim on DDE. 01/23/2020
How do you bill the JW Modifier for the drug amount discarded and/or not administered to the patient if the drug has a Medically Unlikely Edit (MUE)? 01/23/2020
How should I submit Medicare claims for Radium Ra-223? 01/23/2020
I am a provider and need to make a claim adjustment; can I submit a Voluntary Refund Form, include a hard copy check and send it to Finance and Accounting? 01/23/2020
I am receiving reason code W7062, which means 'code not recognized by OPPS; alternative code for same service may be available', on several of our outpatient hospital claims. Where can I find coding guidance? 01/23/2020
I have a claim where all lines are rejected due to reason code 10416. What does this code mean? 01/23/2020
I submitted an electronic adjustment to correct a medically denied line, why was the claim returned to the provider (RTP)? 01/23/2020
My claim contains HCPCS code C9399 (Unclassified drugs or biologicals), and received reason code 32512 indicating that the associated units must be equal to one. Please explain this reason code. 01/23/2020
Provider Contact Center (PCC) Frequently Asked Questions (FAQs): July 2019 - September 2019 01/23/2020
What conditions will contractors allow for exceptions to and extension of timely filing requirements? 01/23/2020
What is a PTAN? 01/23/2020
What is interim billing for prospective payment system hospitals? 01/23/2020
What is the correct billing for drug screens, specifically HCPCS code G0431? 01/23/2020
When is it appropriate to bill 14x Type of Bill (TOB) for lab charges? 01/23/2020
Where can providers find additional information regarding the Recovery Audit Contractor (RAC) process? 01/23/2020
Can we use the therapy progress notes and/or the plan of care documentation without the Physician or Nurse Practitioner signature to code from for Medicare claims? 01/22/2020
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