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


Does the Certifying Physician in the Home Health agency record need to be reported on the claim?What shall I do if I don't have an enrollment record in Medicare?Hospice Beneficiary Election Statement Addendum Frequently Asked Questions (FAQ)Where can I find information about the new Medicare cards project?How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal?Do you have a coding question?What are the ordering and referring edits?Why did my patient's MBI change and which MBI do we use?Provider Contact Center (PCC) Frequently Asked Questions (FAQ): April 1, 2020 - June 30, 2020Provider Contact Center (PCC) Frequently Asked Questions (FAQ): January 1, 2020 - March 31, 2020What is a PTAN?I 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 out why a claim has been returned to the provider (RTP) for correction?Can Medicare Secondary Payer and Tertiary Payer claims be submitted electronically?I submitted an electronic adjustment to correct a medically denied line, why was the claim returned to the provider (RTP)?2021 Penalty for Delayed Request for Anticipated Payment (RAP) Submission for Home Health Agencies: Frequently Asked QuestionsHospice FAQAre there any exceptions for unusual situations regarding the face-to-face requirement?How are medical record requests handled for the Recovery Audit Contractors (RAC) related appeals/redeterminations?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?Can a Medicare patient receive home health and hospice at the same time?Can 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 claim adjustment reason codes will be attached to a N432 or N469 Remittance Advice (RA) remark code on the remit?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 the face-to-face documentation be included with the plan of care (POC) and certification documentation?What value code is utilized by home health agencies to report the CBSA?Are providers required to submit medical records to the Medicare Administrative Contractor (MAC) for Recovery Audit Contractor (RAC) appeals?Does our hospice agency need to submit the notice of election along with the request for additional documentation requests/records?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?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?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?Should our home health agency discharge a patient that elects a Medicare Advantage (MA) Plan (also known as a Medicare HMO)?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?Provider Contact Center (PCC) Frequently Asked Questions (FAQ): October 1 - December 31, 2020When should home health agencies use the new condition code D2 on their claims?As a hospice, are we required to fill out the Medicare Secondary Payer (MSP) questionnaire upon admission and then every 90 days?Some of my patients have open insurance records that they say are not valid anymore. Can you close them so my claims will process?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?If a hospice fails to recertify the patient should the agency discharge the patient or use span code 77?How are visits counted for continuous home care (CHC)?Can a provider remove an incorrect hospice revocation date from a discharge claim?I cannot seem to locate your hospice or home health training manuals on the Palmetto GBA website. Are they obsolete?As the office manager/volunteer coordinator for a hospice, can I take a verbal order from a physician for a hospice referral?Who qualifies as a non-physician practitioner (NPP)?Where can I find information regarding home health patients transitioning from and/or to HMOs?How long should a home health agency retain billing records, and where can I find that information?When do home health claims qualify for the LUPA add-on payment?How do I know if Medicare is primary or secondary?Who are the medical directors for Palmetto GBA?