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  • Palmetto GBA, LLC, Inappropriately Paid Hospitals Medicare Claims . . .
    The objective of this review was to determine whether Palmetto GBA, LLC (Palmetto), the Medicare contractor for Jurisdiction 1, appropriately paid hospitals’ Medicare claims subject to the postacute care transfer policy
  • Part B Insider (Multispecialty) Coding Alert - AAPC
    Ensure you're following the rules by reviewing these 11 citations and quotes from CMS and MACs on critical care time documentation, provided by Todd Thomas, CPC, CCS-P, President of ERcoder, Inc in Edmond, OK 1 CMS Claims Manual 30 6 12 - Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292) E Critical Care Services and Physician Time Critical care is a time- based service
  • Modifier Coding Alert - AAPC
    Modifier AK: Non-Participating Physician If you code for a critical access hospital, you need to use modifier AK on claims for services rendered by physicians that don't participate in a payer's network Palmetto GBA recognizes modifier AK as informational and you may submit it with all HCPCS and CPT® codes
  • Part B Insider (Multispecialty) Coding Alert - AAPC
    A new Comparative Billing Report (CBR) from Palmetto GBA has the details to help you figure out how you compare to other physical therapists Background: In its CBR released March 29, Part B MAC Palmetto GBA focused on claims issues, trends, and benchmarks that the payer has seen for Medicare providers who practice physical therapy (specialty 65)
  • Part B Insider (Multispecialty) Coding Alert - AAPC
    Q0092 (Set-up portable X-ray equipment) is the HCPCS code you need to input Check with your MAC for specific details, but according to Palmetto GBA's portable X-ray report, the MAC should pay for each X-ray procedure set-up "other than retakes of the same procedure" for both individual and multiple patient service
  • OASIS Alert - AAPC
    You'll lose payment if you aren't using this new payer ID number by the deadline If Palmetto GBA is your intermediary you might not be too worried about the impending MAC transition, but you do need to make some important changes if you want to continue getting your Medicare reimbursement Palmetto is the current regional home health intermediary for Region C, which includes Arkansas, Florida
  • palmetto gba | Medical Billing and Coding Forum - AAPC
    Palmetto GBA became our MAC at the beginning of the year With that comes their LCD L33445 Removal of Benign and Malignant Skin Lesions with (or in this case without) a different set of "covered" or "deemed medically necessary" ICD-10 codes
  • Cosign Requirements | Medical Billing and Coding Forum - AAPC
    When an RN performs the Medicare annual wellness visit, is a cosign required by the physician? We've gotten contradicting information As of 5 20 21, Palmetto GBA said a cosign is required because it falls under the incident-to provision, however all documents from CMS say the AWV is not
  • Modifier Coding Alert - AAPC
    Palmetto GBA provides the following instructions for using modifier GC: "Submit this modifier with services that were performed by a resident in a teaching facility under the direction of a teaching physician "This modifier is informational only and may be submitted with all HCPCS and CPT® codes "
  • Evaluate Medical Decision Making in the Emergency Department
    Although not a formal part of CMS’ documentation guidelines, some MACs, such as First Coast, National Government Services (NGS), Novitas, and Palmetto GBA, have created audit tools score sheets that include a Marshfield-like audit tool These tools provide definitions and values for the different components of MDM





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