Frequently Asked Questions


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Frequently Asked Questions Articles


Provider Signature Log FAQsI billed multiple patients on one ambulance trip with HCPCS modifier GM, why are my claims still being denied?When billing psychotherapy with an E/M service, can we include the time spent on the E/M service when selecting the appropriate add-on psychotherapy code?Is the hospital responsible for the payment of the transports while the patient is an inpatient?Should Railroad Medicare PTANs Be Submitted On Claims?Why can't we get claim status, entitlement or deductible information from a customer service representative?My paper claims are rejecting with remittance message N257 - Missing/incomplete/invalid billing provider/supplier primary identifier. I am entering the provider's NPI on the claims. What is wrong with my claims?When billing to Part B on a CMS-1500 (02/12) claim, how should a laboratory report services performed by a reference laboratory?Am I a type or specialty that can order or refer items or services for Medicare beneficiaries?How does a chiropractor submit a claim for an office visit and X-rays to Medicare for the denial of statutorily excluded services for the patient's secondary insurance company?How does the CERT process work?Generally speaking, when we say "objective measures," what does that mean?I have primary payment for a consultation service. My software does not allow me to change the procedure code to an E/M code that Medicare will accept. Since Medicare no longer accepts consultation codes, can I bill the patient the co-pay from the primary insurance and not submit a claim to Medicare?My electronic claims are rejecting with remittance message N198 - Rendering provider must be affiliated with the pay-to provider. What does that mean?Who can help me with questions about establishing electronic funds transfer (EFT)?Who do I call to reopen a processed claim?How do you determine if an ambulance transport is considered emergent?How much is the annual therapy cap?What is the format of a Railroad Medicare Provider Transaction Access Number (PTAN)?Do I have to revalidate my provider enrollment with the RRB SMAC?Please clarify the guidelines for advanced life support (ALS) assessment with no services in response to a 911 dispatch. I thought that if an ALS assessment was done, the transport is automatic, as this was a 911 dispatch.Provider Signature Attestation FAQsWhere can I find coverage and billing guidelines for screening mammograms?Can a service with the GY HCPCS modifier be appealed?Postpayment Review Documentation Requests FAQsWhat are the appropriate procedure codes for the first and subsequent AWVs?What modifiers are required when billing for beneficiaries enrolled in hospice?How is the CERT paid claims error rate determined?When I check eligibility through the IVR will it give me information about Medicare Advantage plan enrollment?Can a single visit be counted as both the IPPE and an AWV?What types of health professionals can perform an Annual Wellness Visit (AWV)?How do I verify the effective date of my electronic fund transfer (EFT)?What provider identification information do I need when I call Customer Service?How can I determine if an MUE value applies to the date of service or the line of service?Can I bill Railroad Medicare for administering a Part D vaccine?Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?How would I know a Railroad patient is enrolled in a Medicare Advantage plan when they presented their Railroad Medicare Card?Why was my ambulance claim denied for missing a beneficiary signature?What is medical review?How is compliance with the CERT contractor's request for medical records beneficial to providers?If a paramedic (not an EMT) is requested for a transport (emergent or non-emergent), but no advanced life support (ALS) procedures are performed is it considered an ALS transport?Where can I find instructions for using the NCCI PTP code pair tables?Is an address required in block 32 of the CMS 1500 (02/12) claim form when the place of service code billed is 12 (Home)?Do subsequent chiropractic visits need new treatment plans?Why was a CC HCPCS modifier added to the procedure code I billed?Does it matter what position pricing modifiers are submitted on a claim?Does Railroad Medicare need copies of our provider's/practice's insurance policy?My claim was denied with remittance messages 183 and N574. I submitted the name and NPI of the ordering/referring provider. What is wrong?How can I check the status of my Appeal request submitted through eServices?Who do I contact to make updates on my EFT banking information?What is Comprehensive Error Rate Testing?How can I check the status of my PTAN request?When do I use the 26 CPT modifier?When billing a drug with HCPCS modifier JW, should the modifier be applied to the amount of the drug that was administered, the amount discarded, or both?What form should be used to adjust a claims that will ultimately result in an overpayment to Medicare?What address are prepayment Additional Documentation Request (ADR) letters sent to?Where can I find an EFT form for Railroad Medicare?Where can I find coverage and billing guidelines for screening pap smears and pelvic exams?Can Railroad Medicare beneficiaries have coverage through a Medicare Advantage plan?When is a Physician Certification Statement (PCS) required for Ambulance services?Do I need to notify Railroad Medicare if we add an additional practice location?When billing time-based psychotherapy, what code should I use when the time spent doing psychotherapy does not match the time in the code descriptions?What should I do if I disagree with a letter of review findings for a review of medical records?Can I request a reopening to remove a claim line?How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?What shall I do if I don't have an enrollment record in Medicare?I rarely file paper claims and do not want to buy new forms. What are my options?I did not receive the prepayment ADR letter Medical Review sent for my claim. How can I get a copy of the letter?What beneficiary identification information do I need when I call Customer Service?I noticed a "multiple procedure" modifier on my remittance advice but I did not submit it. The service was allowed, but should I have included this modifier on my claim?What is the purpose of a Comparative Billing Report (CBR)?Can time be used as a basis for E/M code selection in regards to add-on psychotherapy services?What is a Comparative Billing Report?How do I request immediate offset on an established overpayment due to Railroad Medicare?Can a physician or physician's group bill the modifier to indicate a laboratory test was performed by a reference laboratory?Medicare Secondary Payer (MSP) Frequently Asked QuestionsWhen submitting a diagnostic service for medical review, what documentation is required?What are National Correct Coding Initiative (NCCI) Procedure to Procedure edits?Can a provider request immediate offset for voluntary refunds or for solicited overpayments prior to the 40-day interval?Can other medical services be performed at the same time as an AWV? If so, how are they coded?My claim rejected with remittance message MA116 - Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution. Where do I put "Homebound" on a claim?How can I email a question to Railroad Medicare?Railroad Medicare PTAN Lookup and Request Tool FAQsWhen should I enter an amount in item 29 of the CMS-1500 (02/12) claim form?Can my billing agency or clearinghouse request my PTAN from Railroad Medicare?Can HCPCS modifier JW be billed for the discarded amount of a drug from a multi-use vial?What is the CERT provider compliance error rate?Is a chiropractor required to submit claims for non-covered services, such as an office visit, and how do I know if the patient's secondary insurance will consider the service if Medicare does not cover it?Why can I no longer find the "Request for Railroad Medicare PTAN for Electronic Submitters" form?What is the correct Medicare Secondary Payer (MSP) type to use when filing an electronic claim?Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?If a patient presents to the office for an injection or venipuncture, would it be acceptable to submit an office or other outpatient visit CPT code?If my enrollment status with my Part B local MAC has negatively changed (revoked, suspended, etc.), can I still bill Railroad Medicare?When billing both codes in an NCCI PTP pair, how can I determine which code can billed with an NCCI modifier?The PWK fax cover sheets ask for ACN number, what is an ACN number?Are chiropractors required to report the ordering/referring provider on claims when billing for an X-ray or other diagnostic radiology service?Is the Beneficiary Signature required for emergency ambulance transports?If I provide a statutorily excluded service am I required to have the patient sign an ABN?Our claim was denied for MUE. Can we request a reopening to change the units of service billed?Where can I find a list of HCPCS/CPT codes that are subject to NCCI PTP code pair edits?By the time you received my refund, you had already offset my claim. Why wasn't my refund returned to me?How will we be notified of the review decision?Why aren't we receiving paper checks from Railroad Medicare, even though our remittances show we have received a payment?How should time spent with the patient and/or family member doing psychotherapy be documented?How can I tell if a remittance was paid by paper check or by electronic funds transfer (EFT)?What immunizations does Medicare Part D cover?If a patient is transported by ambulance to hospice prior to the initial assessment and development of the plan of care, what destination modifier do I use?Can I bill you for sending requested documentation for a prepayment or postpayment review?When I check eligibility through the eServices portal will it show Medicare Advantage plan enrollment?When submitting psychotherapy services for medical review, what documentation is required?How do I address Chiropractic treatment goals if I see the patient once and no further treatment is necessary?How long does the CERT contractor have to review the medical records?Does Railroad Medicare cover tetanus shots?My claims are denying because Medicare records show another insurance should be paying as primary to Medicare. The patient has recently retired and says the insurance has ended. Who can I call to get the patient's Medicare record updated?I am a hospitalist and all records for my services are part of the patient's hospital record. Why do Medicare contractors send me the request for medical records and not the hospital?What is the difference between MUE date of service edit indicators MAI 2 and MAI 3?Can an ABN (Advance Beneficiary Notice of Noncoverage) be issued for HCPCS code A0427-ALS 1/Emergency Transports?Where can I find a list of CARCs and RARCs?Am I required to bill with HCPCS modifer JW when reporting waste from a single use drug vial?How often are CARCs and RARCs updated?I received a letter saying I have to file claims electronically with Railroad Medicare and references "ASCA". What does "ASCA" mean?What should we do if we receive multiple requests for medical records from the CERT contractor?The immediate offset form was sent. Why is the overpayment still outstanding?Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?Can we bill a patient for a service that denied due to MUE? Should we issue an Advance Beneficiary Notice (ABN) to the patient in this case?I sent my claim to Railroad Medicare but the IVR and eServices indicate that it is not on file. Should I call and ask a representative to search for the claim?Why was my bilateral procedure denied for MUE? I billed separate lines for the right and left sides.Who do I contact for a copy of my EFT notification letters?What is the status of my electronic funds transfer (EFT) enrollment?I just received my Part B MAC PTAN. How soon can I request a Railroad Medicare PTAN through the PTAN Lookup and Request Tool?My claim denied for timely filing. When can timely filing be waived?Does it matter what position modifiers are submitted on an anesthesia claim?Is Medicare the Primary or Secondary Payer?Where should I send documentation for CERT reviews?What should I do if the beneficiary and/or representative refuses to sign for an ambulance transport?As a rendering physician, how should I report my NPI on a claim? Do I submit differently if I am a member of a group?Do I need to notify Railroad Medicare of a provider or practice name change?If the patient's secondary insurance is requiring a denial from Medicare for services that are statutorily non-covered, how does a chiropractor submit a claim for an office visit and X-rays to Medicare for denial?How do I submit an Appeal online?My paper claim was rejected with remittance message N265? What information was missing?May we fax documentation in response to Additional Documentation Request (ADR) letters?Once I submit a request for immediate offset, what can I expect? Will my debt automatically be paid off? Will interest accrue?Is it acceptable to highlight information in the medical records when responding to a Medical Review Additional Documentation Request (ADR)?My electronic claim was rejected with remittance message N265? What information was missing?Why would the base rate on a hospital-to-hospital transport be paid but the allowed mileage be reduced?How can I get a duplicate remittance notice?What if I can't get a handwritten or electronic signature because the provider is deceased or has left the practice?Does Railroad Medicare cover TDAP shots?What codes should we bill to Railroad Medicare for the administration of a preventive immunization?Does Railroad Medicare cover shingles vaccines?What does MA04 "Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible" mean?How should we calculate the time for time-based psychotherapy services for the purposes of submitting claims?If Medicare determines that my records are not legible, will you treat this as if no documentation is available?What is the TTY/TDD provider service center number for Railroad Medicare Providers?Can an independent laboratory bill both non-referred (i.e., self-reported) and referred services on the same CMS-1500 (02/12) claim form?Does Medicare reimburse for ambulance transportation to and from a physician's office?How can I call Customer Service?Can an independent laboratory bill both non-referred (i.e., self-reported) and referred services on the same electronic claim?If a patient is being transported to a wound care center located within a hospital or on hospital grounds, which destination modifier would be used when filing the claim?Can I use an ABN (Advance Beneficiary Notice of Noncoverage) for chiropractic services?What if I can't get a handwritten or electronic signature because the provider is deceased or has left the practice?What immunizations does Medicare Part B cover?Who do I contact if I have questions about an Electronic Health Record (EHR) Incentive Program overpayment adjustment?I submitted an assigned claim. Why was the payment sent to the patient?How do I access Immediate Offset and electronic payments for Medicare overpayments and voluntary refunds in eServices?Are chiropractors required to submit therapy codes with both the GP and the GY HCPCS modifiers?How do I upload attachments to an appeal request?Can I request an immediate offset through eServices for both demanded overpayments and voluntary refunds?How should I list the name of the ordering/referring provider when submitting my paper and electronic claims?My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong?What are CARCs and RARCs?Who are the Comprehensive Error Rate Testing (CERT) contractors?Do I have to be enrolled with Railroad Medicare to be able to order or refer services for a Railroad Medicare beneficiary?I am an opt-out physician and would like to order and refer services. What do I need to do?Can time alone be used to select an E/M code?Can a provider submit a hospital inpatient, office or outpatient evaluation on the same calendar date as a critical service?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?What are the documentation requirements for billing observation or inpatient hospital care services (including admission and discharge services)?Does time need to be documented in order to submit for a hospital or nursing facility discharge service?What specific information can ancillary staff (e.g., RN, LPN, CNA) document during an evaluation and management (E/M) encounter?Are observation codes submitted by the hour or by the calendar date?Is it acceptable to use 'noncontributory, unremarkable or negative' when reporting past, family or social history?When scoring documentation for E/M services, can a review or order of a pulse oximetry reading be counted as a vital sign under constitutional?If my patient is registered in the emergency department and I am asked to see him/her, may I submit the emergency service?Is it acceptable to document "VSS" (vital signs stable)? How many vital signs must be listed in order to receive "credit" for the 1995 guidelines under "constitutional"?Can "incident to" occur in place of service (POS) 19 or 22 (outpatient hospital)?What is the definition of a 'new patient' when selecting an E/M CPT code?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)?Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?Can a nurse practitioner perform the initial hospital visit?Payment was reduced (down coded) for E/M services because the documentation was not legible to the reviewer. What should I include in an appeal request?Why was my office visit denied when billed on the same surgery date of service?Can we utilize the "status of three or more chronic/inactive conditions" as an extended History of Present Illness (HPI) for the 1995 guidelines?Can I bill for drug wastage from a multi-dose/multiuse vial or package of drug or biological?What is the Qualified Medicare Beneficiary (QMB) program?In my notes, I documented pain and muscle spasm in the lumbar region at L2-L3, but my claim denied due to an incomplete P.A.R.T. exam. Can you explain why?Why do I need to know whether a patient is a Qualified Medicare Beneficiary (QMB)?How Do I Find a Form?I billed for a chemotherapy drug with HCPCS code J9999 and it denied. Why?One physician in a group performed a surgical procedure but a different physician in the same group was responsible for follow up after the surgery. Do we submit as split post-op care?Why was my corrected claim denied for timely filing?Does Medicare allow providers to bill a patient for a missed appointment?Why is documentation required for unlisted codes?What does 'Reasonable and Necessary' mean?Where can I find the Railroad Medicare fee schedules?Does Railroad Medicare have Local Coverage Determinations (LCDs)?Can I call the Telephone Reopening Line to correct a rejected claim?How do I make text larger to make it easier to read?What place of service (POS) do I use when reading a test from a remote location?Where can I find information about the new Medicare cards project?My claim for post-operative services billed with a modifier for 'Postoperative Management Only' was rejected. What information was missing?Is Coumadin or Heparin considered a 'drug requiring intensive monitoring for toxicity' under the Table of Risk?Is a supervising physician's signature required for services performed by a physician assistant in the emergency department?Where can I see the Medically Unlikely Edit (MUE) value assigned to a CPT or HCPCS code?My claim rejected with a remittance message code MA83, saying: Did not indicate whether we are the primary or the secondary payer? What does this mean?My claim rejected with a remittance message code MA83, saying: Did not indicate whether we are the primary or the secondary payer? What does this mean?Why did my patient's MBI change and which MBI do we use?Can my billing agency or clearinghouse update my provider enrollment record with Railroad Medicare?Why do I need a separate Provider Transaction Access Number (PTAN) for Railroad Medicare?How long will it take Railroad Medicare to issue a PTAN?Do I need to notify Railroad Medicare that a provider's address has changed? I have already notified our local Medicare Administrative Contractor (MAC).How do I update my provider information on an existing Railroad Medicare provider number?What is the provider's enrollment effective date with Railroad Medicare?What information do I need to include when I send a written inquiry to Provider Enrollment?How do I report a provider address change?If a forwarding address notification is submitted to the post office when a provider changes site location, will Medicare remittance advices and/or check payments be forwarded to the new address?If my claim is denied for failure to submit requested documentation within 45 days of an Additional Documentation Request (ADR), should I submit a new claim and attach the requested documentation with the new claim?If my claim is denied for failure to submit requested documentation within 45 days of an Additional Documentation Request (ADR), should I submit a new claim and attach the requested documentation with the new claim?Can I print or view remittances online?How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal?If another provider admits a patient into Observation Care and I provide a consult, can I bill the observation care code?Do I need to obtain prior authorization or precertification before I provide a Part B service to a Railroad Medicare patient?Can I call the Reopening line to change the total number of post-operative days I billed?What are the ordering and referring edits?Are Your Medicare Secondary Payer (MSP) Claims Rejecting?Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?