Frequently Asked Questions


Find answers to frequently asked Medicare questions below. You can view additional FAQ for Hospice providers on the CMS website. For help with eServices, view our eServices FAQ.





Frequently Asked Questions Articles


If a hospice fails to recertify the patient should the agency discharge the patient or use span code 77?Can the face-to-face documentation be included with the plan of care (POC) and certification documentation?How are visits counted for continuous home care (CHC)?How long should a home health agency retain billing records, and where can I find that information?Does our hospice agency need to submit the notice of election along with the request for additional documentation requests/records?Can a home health agency (HHA) that provides therapy service and a nursing service on the same day only bill one G-code for that day?How do I know if Medicare is primary or secondary?Who qualifies as a non-physician practitioner (NPP)?Should our home health agency discharge a patient that elects a Medicare Advantage (MA) Plan (also known as a Medicare HMO)?Can a provider remove an incorrect hospice revocation date from a discharge claim?When should home health agencies use the new condition code D2 on their claims?As the office manager/volunteer coordinator for a hospice, can I take a verbal order from a physician for a hospice referral?I have a patient who has an open liability claim on the Common Working File (CWF), but we are seeing him for services not related to the auto accident. How should I file these claims with Medicare?Some of my patients have open insurance records that they say are not valid anymore. Can you close them so my claims will process?Does the Certifying Physician in the Home Health agency record need to be reported on the claim?When do home health claims qualify for the LUPA add-on payment?As a hospice, are we required to fill out the Medicare Secondary Payer (MSP) questionnaire upon admission and then every 90 days?Where can I find information regarding home health patients transitioning from and/or to HMOs?What value code is utilized by home health agencies to report the CBSA?Which benefit, Medicare or Medicaid, is responsible for paying for the months of care provided to the beneficiary before the signed election statement was obtained?How do we handle billing when an HMO patient, who is receiving home health services from us, disenrolls from the HMO and is eligible for Medicare?Can Medicare Secondary Payer and Tertiary Payer claims be submitted electronically?How do I find out why a claim has been returned to the provider (RTP) for correction?What shall I do if I don't have an enrollment record in Medicare?What are the ordering and referring edits?2021 Penalty for Delayed Request for Anticipated Payment (RAP) Submission for Home Health Agencies - Frequently Asked Questions (FAQ)Provider Contact Center (PCC) Frequently Asked Questions (FAQ): January 1, 2020 - March 31, 2020I submitted an electronic adjustment to correct a medically denied line, why was the claim returned to the provider (RTP)?What is a PTAN?I cannot seem to locate your hospice or home health training manuals on the Palmetto GBA website. Are they obsolete?Can a Medicare patient receive home health and hospice at the same time?Hospice Beneficiary Election Statement Addendum Frequently Asked Questions (FAQ)Provider Contact Center (PCC) Frequently Asked Questions (FAQ): October 1 - December 31, 2020Can a Medicare patient receive home health and hospice at the same time?Who should a provider contact about status of refund due to a Recovery Audit Contractor (RAC) retraction letter?What is the Recovery Audit Contractor (RAC) appeal/redetermination process?If a Recovery Audit Contractor (RAC) retracts due to a discussion or internal error, how is Palmetto GBA notified? What are the internal processes and timeframes?What claim adjustment reason codes will be attached to a N432 or N469 Remittance Advice (RA) remark code on the remit?Does Palmetto GBA send the provider any communication that states the payment amount due includes the accrued interest for Recovery Audit Contractors (RAC) appeals that have gone to the Quality Improvement Organization (QIO) after the decision?Are providers required to submit medical records to the Medicare Administrative Contractor (MAC) for Recovery Audit Contractor (RAC) appeals?How are medical record requests handled for the Recovery Audit Contractors (RAC) related appeals/redeterminations?Where can I find information about the new Medicare cards project?Who are the medical directors for Palmetto GBA?Are there any exceptions for unusual situations regarding the face-to-face requirement?Why did my patient's MBI change and which MBI do we use?Did You Know that Your Claim Can Receive the Specific Granular Error - The Face-to-Face Encounter Not Present for Denial Code 5FF2F/5TF2F Even If That Documentation Was Submitted?Hospice FAQI have a lot of claims in 'S' status with reason code 30928. Can someone explain why my claims are being held?How 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