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Frequently Asked Questions

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TOPICS: A

ABN  (3 questions)

Billing/Payment

ADA  (0 questions)

ADR  (3 questions)

Billing/Payment
General Information

APC  (0 questions)

ASCA  (23 questions)

Forms
General Information
Requirements

Additional Development Request  (3 questions)

Billing/Payment
General Information

Additional Documentation Request  (0 questions)

Adjustments  (4 questions)

Billing/Payment

Administrative Simplification Compliance Act  (23 questions)

Forms
General Information
Requirements

Advance Beneficiary Notice of Noncoverage  (3 questions)

Billing/Payment

Ambulance  (2 questions)

Billing/Payment
Coverage

Ambulatory Payment Classification  (0 questions)

American Diabetes Association  (0 questions)

Ancillary  (0 questions)

Annual Wellness Visit  (0 questions)

Appeals  (4 questions)

Billing/Payment
General Information
Requirements

Aranesp  (0 questions)


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Popular Topics

This list is the most-used topics that users looked at in the last 30 days.
1. ASCA
2. Ambulance
3. ADR
4. Adjustments
5. Appeals
6. ABN
7. Hospice
8. Home Health
9. Enrollment
10. FISS/DDE

Top Questions

This list is the most-used questions that users have looked at in the last 30 days.
1. When is a condition code 20 used?
2. Why do I receive reason code 39011 for untimely submissions and appeal requests?
3. Is provider action ever needed for suspended claims?
4. When is occurrence code 32 used?
5. Where do we mail our Administrative Simplification Compliance Act (ASCA) waiver request?
6. Where should a Michigan provider send additional development requests (ADR)?
7. Does Medicare pay for an ambulance transport that is not medically necessary?
8. Can a provider view additional development requests (ADRs) via the Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System?
9. How do I adjust a claim that has been medically denied?
10. How is an ambulance transport (provided by a hospital-owned ambulance provider) unrelated or related to hospice billed?

Recently Added

This lists the top-ten most recently added questions in our FAQ database.
1. Do I need to send a separate appeals request for each service/procedure code on the claim?
2. How can I determine whether my patient has reached the therapy threshold?
3. If the provider (therapist) is an employee of a SNF treating a Medicare Part B patient, who is listed as the provider? The therapist or the SNF?
4. Who may certify a plan of care?
5. What should a therapy plan of care contain?
6. In which situations would the beneficiary be liable for therapy services?
7. How was it determined what phase I am in?
8. Are we required to submit a claim to Medicare if the primary payer paid the claim in full?
9. How are early and later home health episodes defined?
10. Why did my home health claim reject indicating it needs to be billed as a transfer? The patient was discharged from the previous home health agency (HHA) over a month ago.
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