Tips for providers submitting appeals for multiple beneficiaries as a single...
First Coast Service Options Inc. (First Coast) has determined that some providers are submitting multiple re determination requests for multiple beneficiaries in a single package using a single roster...
View ArticleCan appeal limit can be extended?
Appeal and Time limit filingGood cause for extension of the time limit for filing appealsThe time limit for filing a request for redetermination may be extended in certain situations. Generally,...
View ArticleAvoiding reject reason code U5200 and U5233
Q: We are receiving reason code U5200, indicating no record of Part A entitlement for the beneficiary. What steps can we take to avoid this reject?Reason Code : U5200 Description: NO ENTITLEMENT -...
View ArticleHow can we do Immediate Offset Requests
Beginning July 1, 2012, a new, standard immediate offset process was implemented for all Part A providers, Home Health & Hospice providers and all Part B physicians and other suppliers. This new...
View ArticleInsufficient Documentation Denial
The Centers for Medicare & Medicaid Services (CMS) implemented the CERT program to measure improper payments in the Medicare Fee-for-Service (FFS) program. Under this program, a random sample of...
View Articlewhen we can do Part B clerical reopening
When to file an appealOnce an initial claim determination is made, providers, participating physicians, and other suppliers have the right to appeal. Physicians and other suppliers who do not take...
View ArticleWhen Medicare Pays For Ambulance Services
Ambulances transport critically ill or injured passengers to hospitals every day. They also take patients with non-emergency conditions to hospitals, critical access hospitals, skilled nursing...
View ArticleHHC Denials and Action for Request Records Not Submitted and Information...
Auto Deny - Requested Records Not Submitted Medical records were not received in response to an Additional Documentation Request (ADR) in the required time frame; therefore, we were unable to...
View ArticleHospice Medical Review Top Denial Reason Codes:
The claim has been fully or partially denied as documentation submitted for review did not include a plan of care (POC) for all or some of the dates billed.How to prevent this denial•The hospice must...
View ArticleHospice denial and Actions for - Requested Records not Submitted, Face to...
Auto Deny - Requested Records not SubmittedMedical records were not received in response to an Additional Documentation Request (ADR) in the required time frame; therefore, we were unable to determine...
View ArticleHospice claim - Invalid Plan of Care, No Certification Present – Denials and...
Invalid Plan of CareThe claim has been fully or partially denied as the documentation submitted for review did not include a valid plan of care for all or some of the dates billed.For a beneficiary to...
View Articlehow to resolve New Patient Visits by Same Physician or Physician Group:...
Medicare's Common Working File (CWF) system detects erroneous billings when there are two new patient CPT codes being billed within a three-year period of time by the same physician or physician...
View ArticleOverpayments: Identifying Specific Patients
Each overpayment letter mailed by Palmetto GBA contains one or more Invoice Numbers as well as a list of the specific patients and dates of service included in the overpaid amount(s). The same Invoice...
View ArticleHome Health Medical Review Top Denial Reason Codes
All providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely.Face to Face Encounter Requirements Not Met The services billed were not...
View ArticleDenial code - 5DOW4 – Partial Denial Resulting in a LUPA
Home Health Service Denial and Action5DOW4 – Partial Denial Resulting in a LUPABased on the medical records submitted for review, a portion of the services provided was denied. This resulted in a Low...
View ArticleHospice: Claims Rejected with Reason Code C7010
Palmetto GBA has identified claims that have been submitted for beneficiaries that have elected the hospice benefit and receiving inpatient, home health or other services related to the terminal...
View ArticlePsychiatric Services Coverage/Reimbursement CPT code 90834
Psychotherapy probe review findingsFirst Coast Service Options Inc. (First Coast) recently conducted post payment provider specific probes reviews in response to data aberrancies identified for Current...
View ArticleBCBS rejection Billing provider Tax ID/EIN submitted does not match BCBSF files
Recently BCBSFL has been started to reject the claim as.Rejected: 043:Billing provider Tax ID/EIN submitted does not match BCBSF files. This required provider information update form to process the...
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How to check the Flu shot benefits - eligibility verification
Its flu season hene verifying patient benfits for Flu shot is must . Here we have given the way to verify the benefits. Its a same method as we generally used for medical benefit and the only...
View ArticleImmediate Offset Requests
Beginning July 1, a new, standard immediate offset process was implemented for all Part A providers, Home Health & Hospice providers and all Part B physicians and other suppliers. This new process...
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