Palmetto Medicare helps seniors in Columbia, SC and surrounding areas understand their options and choose a Medicare healthcare plan that they're satisfied with. From standard plans, like Medicare Advantage and Medicare supplemental, to add-ons, like vision and dental, we can match you with the right combination to meet your healthcare needs.
Full Answer
Is Palmetto the same as Medicare?
What is Railroad Medicare? Palmetto GBA is the Railroad Retirement Board Specialty Medicare Administrative Contactor (RRB SMAC). We process Part B fee-for-service claims for Railroad Medicare beneficiaries nationwide.
What states does Palmetto Medicare cover?
Contact DetailsOrganization Type:A/B MAC -- A/B Medicare Administrative ContractorOrganization Description:Part A and B bills and services.Covered States and Territories:Alabama, Georgia, TennesseeInformation:Toll Free: 877-567-7271 Web Site: https://www.palmettogba.com/ Hours: 8:00am-5:00pm1 more row
Is Palmetto part of Medicare?
The federal Centers for Medicare & Medicaid Services (CMS) has selected Palmetto GBA as the Medicare Administrative Contractor for Jurisdiction J, which includes the states of Alabama, Georgia and Tennessee.
Which parts of Medicare are offered by private insurers?
What does Medicare Part C cover? Part C is also known as Medicare Advantage. Private health insurance companies offer these plans.
What insurance is Palmetto?
Palmetto Insurance Group is a full-service employee benefit consulting and advisory firm specializing in helping businesses purchase and manage insurance for more than 20 years. We are dedicated to a no-nonsense approach to health insurance.
What is the difference between Medicare and Railroad Medicare?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment.
What is Palmetto?
Definition of palmetto 1 : any of several usually low-growing fan-leaved palms especially : cabbage palmetto. 2 : strips of the leaf blade of a palmetto used in weaving.
What is a Medicare administrative contractor?
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
What Medicare jurisdiction is Virginia?
A/B MAC Jurisdiction M (formerly known as Jurisdiction 11) – Part A and Part B Facts. JM processes FFS Medicare Part A and Part B claims for North Carolina, South Carolina, Virginia, and West Virginia.
What are the top 3 Medicare Advantage plans?
The Best Medicare Advantage Provider by State Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.
What will Medicare not pay for?
In general, Original Medicare does not cover: Long-term care (such as extended nursing home stays or custodial care) Hearing aids. Most vision care, notably eyeglasses and contacts. Most dental care, notably dentures.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
Jurisdiction M Part B MAC
The telephone hotline 1-833-820-6138 has been created for providers and suppliers to initiate provisional temporary Medicare billing privileges and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver. The hotline is available Monday through Friday, from 8:30 a.m. to 5 p.m. ET. Learn More
COVID-19 Provider Enrollment and Accelerated Payment Telephone Hotline
The telephone hotline 1-833-820-6138 has been created for providers and suppliers to initiate provisional temporary Medicare billing privileges and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver. The hotline is available Monday through Friday, from 8:30 a.m. to 5 p.m. ET. Learn More
When did Medicare start paying for surgical procedures?
Medicare established global surgical packages (PDF, 645 KB) in 1992 which include all the necessary services normally furnished by a surgeon before, during and after a procedure. In these instances, Medicare payment for a surgical procedure includes the preoperative, intraoperative and postoperative services routinely performed by the surgeon.
Do optometrists have to be covered by Medicare?
In addition to adhering to state law scope of practice requirements, services provided by optometrists must be medically reasonable and necessary for the diagnosis or treatment of illness or injury in order to be covered by Medicare, and must meet all applicable coverage requirements. While the state laws and regulations are ...
Is it a crime to offer a referral to Medicare?
The anti-kickback statute makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive any remuneration to induce or reward referrals of items or services reimbursable by Medicare or any other federal health care program. Preoperative visits after the decision is made to operate.
Does Medicare cover optometry?
Medicare Coverage of Optometry and Co-management Services. Optometry. Medicare considers a doctor of optometry as a physician with respect to all services the optometrist is authorized to perform under state law or regulation. Optometrists are licensed by the state in which they practice, and their scope of optometric practice is determined by ...
When is additional documentation required for Palmetto GBA?
The submission of additional documentation is required only when certain CPT/HCPCS codes are billed, or when additional documentation is needed for Palmetto GBA to process and or price a service .#N#When required, additional documentation should be submitted using the eServices portal and your claim must include the necessary information (electronic claim PWK segments or Item 19 on the CMS-1500 claim form) to alert Palmetto GBA that you have submitted required documentation.#N#Whether you are submitting your additional documentation via eServices or fax, the following PWK data elements must be completed on your electronic claim.#N#Loop 2300#N#PWK01 (Attachment Report Type Code)#N#Use the values indicated in the TR3 to identify the type of attachment. Examples:
Does Palmetto GBA require documentation?
Important Note: While Palmetto GBA has made every attempt to identify all services that will require additional documentation, the nature of health care and changes in coding and pricing requirements, the above list is not all-inclusive.#N#Palmetto GBA reserves the right to require additional documentation for any claim.#N#Claims rejected with the following Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) identified on a remittance advice would indicate documentation is required and the claim should be resubmitted as a new claim with the necessary documentation. Providers receiving these rejections for lack of documentation should make note and include documentation with any claim submitted in the future for the service (s).
Document 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, §1862 (a) (1) (A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Coverage Guidance
This is a NON-coverage policy for all platelet-rich plasma (PRP) injections and/or applications as a means of managing musculoskeletal injuries and/or joint conditions.
