Is Palmetto GBA the same as Medicare?
What is Palmetto GBA Railroad Medicare?
How do you bill Railroad Medicare?
- Step 1: Ensure your enrollment information is correct with your local Part B Medicare Administrative Contractor (MAC) ...
- Step 2: Request a Railroad Medicare PTAN. ...
- Step 3: Receive your Railroad Medicare PTAN. ...
- Step 4: File Electronically. ...
- Step 5: Go Green — Electronic Remits.
What states does Palmetto Medicare cover?
| Organization Type: | A/B MAC -- A/B Medicare Administrative Contractor |
|---|---|
| Organization Description: | Part A and B bills and services. |
| Covered States and Territories: | Alabama, Georgia, Tennessee |
| Information: | Toll Free: 877-567-7271 Web Site: https://www.palmettogba.com/ Hours: 8:00am-5:00pm |
Where is Palmetto GBA located?
What is the payer ID for Medicare Railroad?
Is Railroad Medicare different from Medicare?
Is Medicare and Railroad Medicare the same?
Is Railroad Medicare changing ID numbers?
What does HHH mean in Medicare?
| Acronym | Definition |
|---|---|
| HHH | Home Health and Hospice |
| HHS | Department of Health and Human Services |
| HIC | Health Insurance Claim |
| HICN | Health Insurance Claim Number (Medicare Number) |
What is a Medicare administrative contractor?
Is Palmetto GBA a fiscal intermediary?
What is a CMS-1500?
The CMS-1500 claim form answers the needs of many insurers. It is the basic form prescribed by the Centers of Medica re & Medicaid Services ( CMS) for the Medicare program for claims from physicians and suppliers.
What is a Medigap policy?
Medigap: A Medigap policy meets the statutory definition of a "Medicare supplemental policy" contained in Section 1882 (g) (1) of Title XVIII of the Social Security Act and the definition contained in the NAIC Model Regulation, which is incorporated by reference to the statute.
1. If, prior to the hospital billing Medicare, a liability insurer settles and makes a payment directly to the patient, do we still submit a claim as MSP? Will the claim deny for us to bill the patient for the allowed amount?
1. If, prior to the hospital billing Medicare, a liability insurer settles and makes a payment directly to the patient, do we still submit a claim as MSP? Will the claim deny for us to bill the patient for the allowed amount?#N#Yes, the claim is still MSP. Once the claim is processed, beneficiary liability can then be determined.
2. If a beneficiary only has Part A hospital coverage, do we have to bill Medicare if it is primary and the patient was seen in-office?e
2. If a beneficiary only has Part A hospital coverage, do we have to bill Medicare if it is primary and the patient was seen in-office?e#N#No. If the beneficiary does not have Part B coverage, then a provider would not need to bill for an office visit unless you need the denial stating the beneficiary has no Part B coverage.
5. We have a patient who fell asleep at the wheel and hit a tree. She stated she did not want us to file a claim with her auto insurance. What should we do when a patient does not want us to bill their auto insurance, although the care they seek is related to the auto accident?
If you know the claim is an MSP issue, providers are required to bill the primary insurance prior to submitting to Medicare.
7. We have a patient who was in an auto accident, but they received the full med pay payment. What should we do?
When the beneficiary is paid directly by no-fault insurer, payment should be paid to the provider by the beneficiary. Report the amount paid by the primary insurer with appropriate coding on the claim. Medicare will process as secondary payer and the provider will need to contact the beneficiary for the primary payment resolution.
9. When filing a claim with condition code 08 when beneficiary is not cooperating, how do we prevent these from returning to the provider?
The Part A claim should reject and assign responsibility to the patient. Contact customer service for assistance with the claim.
10. Where are the instructions for completing the CMS-1500 when billing MSP? Is there another form specific for MSP billing rather than the CMS-1500 to submit MSP claims?
No. The CMS-1500 (or the electronic equivalent) is the Part B claim form, which is used for billing MSP claims as well.
11. Are MSP claims sent to Medicare the same way as normal Medicare claims?
Yes, except for attaching a primary explanation of benefits (EOB) if billing on paper and if electronic, filling in some fields not found on the CMS-1500.
Is Medicare a defined benefit program?
Medicare is a defined benefit program. In order to be considered for Medicare coverage, an item or service must fall within a statutory benefit category .
What is a screening test?
Tests considered screening in the absence of clinical signs and symptoms of disease that are not specifically identified by the law. Tests that confirm a diagnosis or known information. Tests to determine risk for developing a disease or condition. Tests performed to measure the quality of a process.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1833 (e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim
Article Guidance
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for the Outpatient Physical Therapy L34428 LCD.
