Frequently Asked Questions


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Frequently Asked Questions Articles


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?Can a provider bill a skilled nursing facility (SNF) or swing bed (SB) claim if the patient does not have a qualifying hospital stay?What is interim billing for prospective payment system hospitals?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.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.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?Where can providers find additional information regarding the Recovery Audit Contractor (RAC) process?When is it appropriate to bill 14x Type of Bill (TOB) for lab charges?How do I find out why a claim has been returned to the provider (RTP) for correction?What is the timeframe for submitting a claim adjustment?How do I bill my claims when a patient revokes or elects hospice coverage during his/her inpatient stay?A Local Coverage Determination (LCD) is denoted as superseded on the CMS website.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.What is the correct billing for drug screens, specifically HCPCS code G0431?Can Medicare Secondary Payer and Tertiary Payer claims be submitted electronically?How do I bill my claims when a patient revokes or elects hospice coverage during his/her inpatient stay?For the new A/B Rebilling process, what should be billed on the 13x type of bill (TOB) versus on the 12 TOB?Where is the SNF consolidated billing list? I have researched this on the CMS website and went to the SNF consolidated billing section, but I was never able to locate an actual list that shows any codes.What conditions will contractors allow for exceptions to and extension of timely filing requirements?How should I submit Medicare claims for Radium Ra-223?How should units be billed for outpatient Bevacizumab (Avastin) services?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?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)?I have a claim where all lines are rejected due to reason code 10416. What does this code mean?Are hospital labs that file institutional claims exempt from the MolDx Program requirements?We have a clinical pharmacist onsite that wants to talk to patients about their medications. Can the FQHC bill this service under Medicare Part A as a core visit?I submitted an electronic adjustment to correct a medically denied line, why was the claim returned to the provider (RTP)?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?Provider Contact Center (PCC) Frequently Asked Questions (FAQ): January 1, 2020 - March 31, 2020Provider Contact Center (PCC) Frequently Asked Questions (FAQ): July 1 - September 30, 2020What does 'forwarding balance' mean on my remittance notice?Provider Contact Center (PCC) Frequently Asked Questions (FAQs): October 1 - December 2020A 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?What is a PTAN?How do I make text larger to make it easier to read?Who are the medical directors for Palmetto GBA?Why did my patient's MBI change and which MBI do we use?I have a lot of claims in 'S' status with reason code 30928. Can someone explain why my claims are being held?Claims Overlap FAQHow do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal?Do you have a coding question?Provider Contact Center (PCC) Frequently Asked Questions (FAQ): April 1, 2020 - June 30, 2020