skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
En Español
Text Size:
Close
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]

Answers

1995 Examination guidelines
Modified: 10/7/2020
This based on E/M FAQs submitted by providers.
36428
Modified: 9/23/2020
To help you increase the number of claims that pass through edits and into processing, here are the top reasons for rejected claims as well as tips and resources to help you avoid many of these errors. [First Coast's Education Action Team]
ADR by fax FAQ
Modified: 8/20/2020
ADR response time FAQ
Modified: 10/5/2020
Access remittances via SPOT FAQ
Modified: 8/28/2020
Accuracy of beneficiary information FAQ
Modified: 8/6/2020
Adding a provider to a group
Modified: 10/19/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Additional documentation request FAQ
Modified: 9/23/2020
Will First Coast's medical review (MR) department request additional documentation from providers during the CERT process?
Additional records submission during appeals FAQ
Modified: 10/7/2020
Questions and answers pertaining to Medicare Part A appeals and redeterminations.
Address change notification
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Adjust or resubmit claim rejects FAQ
Modified: 10/3/2020
Adjustment and cancel claim data requirements FAQ
Modified: 9/19/2020
Advance Beneficiary Notice of Noncoverage and ambulance services
Modified: 10/7/2020
Question relating to CMS guidelines regarding use of ABN in relation to ambulance services.
Ambulance claims and signature requirements
Modified: 9/24/2020
FAQ regarding signature requirements on ambulance claims
Amount in controversy (AIC) FAQ
Modified: 10/7/2020
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Appeal rights for DRG change recommendation FAQ
Modified: 10/7/2020
Appeals FAQ
Modified: 10/24/2020
[First Coast Education Action Team]
Application fee
Modified: 9/14/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Applications with incomplete information
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Are observation codes considered outpatient or inpatient?
Modified: 10/2/2020
E/M FAQ re observation codes
Are there differences between the First Coast Part B fee schedule look-up, PDF files, and zipped text files?
Modified: 9/11/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
At what time and date does observation care begin?
Modified: 10/8/2020
E/M FAQ question number 17
Automatic use of lifetime reserve days FAQ
Modified: 8/20/2020
Avoidable CERT error FAQ
Modified: 9/23/2020
What is the most common, avoidable CERT error? How can it be avoided?
Avoiding RTP reason code 31255, 31256, 31257 FAQ
Modified: 10/3/2020
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding RTP reason code N5052 FAQ
Modified: 8/13/2020
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding reason code 76474 FAQ
Modified: 10/2/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Avoiding reject reason code U5200 FAQ
Modified: 10/29/2020
Questions and answers pertaining to verifying beneficiary eligibility.
Beneficiary eligibility and claim status FAQ
Modified: 8/6/2020
Billing PTA services ‘incident to’ physician services FAQ
Modified: 8/13/2020
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Billing modifier 50 FAQ
Modified: 7/10/2020
Questions and answers pertaining to specific modifiers.
Billing modifier 59 FAQ
Modified: 8/4/2020
Questions and answers pertaining to specific modifiers.
Billing modifier 79 FAQ
Modified: 8/4/2020
Questions and answers pertaining to specific modifiers.
Billing multiple modalities in same 15 minutes FAQ
Modified: 8/13/2020
Billing of separate, same-day critical care services
Modified: 10/7/2020
E/M FAQ re separate, same-day critical care services
Billing physician assistant services ‘incident to’ a doctor FAQ
Modified: 9/22/2020
Question and answer pertaining to services which can be billed "incident to" another provider's service.
CMS-1500 paper claim form FAQ
Modified: 9/20/2020
Question and answer referencing mailing address for CMS-1500 paper claim form.
CMS-460
Modified: 8/3/2020
Question and answer pertaining to Medicare enrollment applications.
CR 6417 overview FAQ
Modified: 8/18/2020
[SE1011, CR 6417]
Can I request early offset of a demanded debt FAQ
Modified: 10/9/2020
Question and answer pertaining to early offset of a demanded debt.
Can a request for offset/recoupment be made at the same time I notify Medicare of an overpayment FAQ
Modified: 9/11/2020
Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ
Modified: 10/5/2020
Questions and answers pertaining to Medicare Part B appeals and redeterminations.
Certification statement of the CMS-855
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Change of address and Type 2 National Provider Identifier (NPI)
Modified: 8/20/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Changing password
Modified: 9/9/2020
Question and answer pertaining to changing passwords in PECOS I&A.
Claim reopening vs adjustment FAQ
Modified: 9/19/2020
Claim reopening: Accessing the claim FAQ
Modified: 8/29/2020
Claim reopening: Request types FAQ
Modified: 10/10/2020
Claims overlap FAQ
Modified: 8/27/2020
Clinical psychologist -- enrollment application
Modified: 8/28/2020
Question and answer pertaining to Medicare enrollment application for clinical psychologists.
Coding mileage for ambulance transport FAQ
Modified: 9/24/2020
Questions and answers pertaining to ambulance services.
Coding mileage in the CMN FAQ
Modified: 8/15/2020
Questions and answers pertaining to ambulance services.
Common reason for adjusting and reopening claims FAQ
Modified: 10/3/2020
Compatibility view and other causes of reopening errors - FAQ
Modified: 8/29/2020
Critical care and moment of crisis FAQ
Modified: 7/10/2020
E/M FAQ regarding Critical care
Critical care and separate E/M on same day FAQ
Modified: 8/4/2020
Date of service for ambulance provider claims
Modified: 9/24/2020
FAQ regarding recording of date of service of ambulance claims
Definition FAQ
Modified: 8/17/2020
Delegating authority to sign CMS-855B applications
Modified: 8/20/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS. [Medicare Program Integrity Manual, Chapter 15, Section 15.5.16]
Delete internet-based PECOS application
Modified: 9/9/2020
Question and answer pertaining to deleting applications in Internet-based PECOS.
Denial reason code CO 50/PR 50 FAQ
Modified: 10/24/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors. [First Coast's Education Action Team]
Denial reason code CO 97 FAQ
Modified: 10/3/2020
[First Coast Education Action Team]
Denial reason code CO B9 FAQ
Modified: 8/27/2020
[First Coast Education Action Team]
Denial reason code CO/PR B7 FAQ
Modified: 10/3/2020
[First Coast Education Action Team]
Denial reason code CO22 FAQ
Modified: 10/7/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Denial reason code CO236 FAQ
Modified: 10/24/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Denial reason code OA18 FAQ
Modified: 8/27/2020
Question and answer pertaining to ANSI code OA-18.
Denial reason code PR 170 FAQ
Modified: 8/7/2020
[First Coast Education Action Team]
Departmental appeals board (DAB) FAQ
Modified: 7/10/2020
Recovery Audit Contractor departmental appeals board
Determining overall risk for medical decision-making
Modified: 9/24/2020
Submitted in response to provider E/M inquiries
Determining the provider’s legal name
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Difference between LCDs and NCDs FAQ
Modified: 7/29/2020
Review answer pertaining to local coverage determinations (LCDs) and national coverage determinations.
Difference between ‘ordering/referring provider’ and ‘billing provider’ FAQ
Modified: 8/11/2020
Documentation support FAQ
Modified: 9/4/2020
Documenting history component
Modified: 8/26/2020
Submitted in response to provider E/M inquiries and 2019 update to Federal Register
Duplicate reject/return to provider (RTP) reason code FAQ
Modified: 10/2/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
EDI FAQ
Modified: 8/17/2020
EFT FAQ
Modified: 8/18/2020
EIDM: Account sharing forbidden FAQ
Modified: 5/8/2020
EIDM: Account sharing forbidden FAQ
Modified: 10/1/2020
EIDM: Forgot Password/User ID FAQ
Modified: 10/1/2020
EIDM: View/Modify ‘My Profile’ FAQ
Modified: 8/5/2020
EIDM: View/Modify ‘My SPOT Access Profile’ FAQ
Modified: 9/5/2020
Effective date FAQ
Modified: 8/3/2020
Effective date and retrospective billing
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Eligibility for QMB beneficiary's FAQ
Modified: 8/1/2020
Eligibility requirements for ordering/referring providers FAQ
Modified: 8/18/2020
[CR 6417]
Enrolling or changing information online
Modified: 8/20/2020
Question and answer pertaining to Internet-based PECOS.
Entering POS on claims FAQ
Modified: 7/6/2020
Question and answer pertaining to entering place of service (POS) codes on claims.
FAQ Negative Reimbursement (Deductible/Coinsurance)
Modified: 10/24/2020
FAQs on provider enrollment revalidation cycle 2 for Puerto Rico providers
Modified: 8/11/2020
Fastest way to find a list of active LCDs FAQ
Modified: 7/29/2020
Review answer pertaining to local coverage determinations (LCDs) and the fastest way to find active LCDs.
Federal sequestration payment reductions FAQs
Modified: 8/5/2020
Questions and answers pertaining to the 2-percent reduction in Medicare payments due to federal sequestration.
Fee schedules for specific services -- Part A
Modified: 8/7/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Find out about changing LCDs FAQ
Modified: 9/16/2020
Review answer pertaining to local coverage determinations (LCDs) and how to find out about new and changes to existing LCDs.
Finding information on common modifiers FAQ
Modified: 8/4/2020
Questions and answers pertaining to specific modifiers.
GY modifier and dual diagnosis requirement on ambulance claims
Modified: 9/25/2020
Here is a question relating to use of GY modifier on ambulance claims, if dual diagnosis requirement still applies.
Global surgery care visits FAQ
Modified: 8/6/2020
Modifier 24 FAQ #6
Good standing letter
Modified: 8/28/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Guidance when odometer does not measure fractional mileage
Modified: 8/27/2020
Questions and answers pertaining to ambulance services.
Guidelines for reference to previous notes
Modified: 8/15/2020
Submitted in response to provider E/M question
Guidelines regarding HPI and negative responses
Modified: 10/24/2020
Submitted in response to provider E/M inquiries
Guidelines regarding a complete ROS
Modified: 10/7/2020
Submitted in response to E/M inquiries from providers
Guidelines regarding designation of "old" or "new" problems
Modified: 10/14/2020
Submitted in response to E/M inquiries from providers
Guidelines regarding elements of History
Modified: 8/20/2020
Submitted in response to provider E/M inquiries
Guidelines regarding how allergies apply to History component
Modified: 8/20/2020
Submitted in response to provider E/M inquiries
Guidelines regarding prescription drug management
Modified: 10/2/2020
Submitted in response to provider E/M inquiries
Guidelines regarding review of old records
Modified: 10/14/2020
Submitted in response to provider inquiries re E/M guidelines.
Guidelines selection FAQ
Modified: 8/20/2020
HPI and acute/chronic diseases
Modified: 10/7/2020
Submitted in response to E/M inquiries from providers
Hospice denial FAQ
Modified: 7/10/2020
Hospice overlap & MA FAQ
Modified: 9/19/2020
Hospice overlaps inpatient stay FAQ
Modified: 8/27/2020
Hospital visits and incident to provisions FAQ
Modified: 10/2/2020
Question and answer pertaining to services which can be billed incident to another provider's service.
How and when will I be notified of the review results?
Modified: 8/14/2020
How can I determine my locality?
Modified: 8/19/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
How did I get selected for post-payment service-specific review?
Modified: 8/14/2020
How do I submit my EDI application using SPOT?
Modified: 8/1/2020
How do I submit my medical record documentation?
Modified: 9/18/2020
return documentation, medical records
How do I submit my medical records documentation?
Modified: 8/14/2020
How do I suppress claims that are in a 'T' (returned to provider) status location in direct data entry (DDE)?
Modified: 10/1/2020
How do providers determine when Medicare is the secondary payer FAQ
Modified: 9/4/2020
Question and answer pertaining to how providers can determine when Medciare is the secondary payer. [CMS website]
How do providers get selected for TPE?
Modified: 6/17/2020
TPE selection process
How do providers prepare documentation for submission?
Modified: 8/14/2020
How do providers prepare documentation for submission?
Modified: 6/17/2020
return documentation, medical records
How do providers receive education?
Modified: 8/14/2020
How is a Medicare secondary payment determined FAQ
Modified: 9/11/2020
Question and answer pertaining to how Medicare secondary payment is determined.
How is the error rate determined?
Modified: 6/17/2020
error rate
How many EIDM accounts vs. SPOT profiles FAQ
Modified: 10/10/2020
How to complete a CMS-855 form
Modified: 8/20/2020
Question and answer pertaining to Internet-based PECOS.
How to determine further work-up under number of diagnoses
Modified: 10/2/2020
Submitted in response to provider E/M inquiries
How to join a First Coast webcast FAQ
Modified: 9/25/2020
How to login to SPOT FAQ
Modified: 8/29/2020
How to participate in a First Coast webcast FAQ
Modified: 10/25/2020
How to register for SPOT
Modified: 10/19/2020
How will I be notified of my TPE review results?
Modified: 6/17/2020
review results
How will the provider receive the ADRs?
Modified: 8/14/2020
ILT classes FAQ
Modified: 8/29/2020
ILT registration FAQ
Modified: 8/26/2020
If First Coast calls for education and is unable to reach the provider, how many additional call attempts will be made?
Modified: 6/17/2020
education call attempts
If First Coast calls for education and is unable to reach the provider, how many additional call attempts will be made?
Modified: 6/17/2020
education call attempts
Inactive periods FAQ
Modified: 9/18/2020
Indicating an anti-markup diagnostic service on a claim FAQ
Modified: 7/6/2020
Question and answer regarding the indication of an anti-markup diagnostic service on a claim.
Indication of billing entity provider number FAQ
Modified: 8/6/2020
Question and answer pertaining to indicating provider numbers on claims.
Indication of rendering physician billing number FAQ
Modified: 7/10/2020
Question and answer regarding the indication of rendering physician billing numbers on claims.
Inpatient admit prior to entitlement FAQ
Modified: 8/8/2020
Inpatient hospital entitlement changes FAQ
Modified: 8/7/2020
Interns and residents wishing to order/refer FAQ
Modified: 8/12/2020
[SE 1011]
Interval history FAQ
Modified: 8/31/2020
Introduction to modifiers FAQ
Modified: 8/4/2020
Questions and answers pertaining to specific modifiers.
Is there a timetable available to help determine if a claim meets the criteria as cost outlier?
Modified: 8/13/2020
Answer to the question regarding a timetable for coding inpatient cost outlier claims.
Is this review the same as targeted probe and educate (TPE)?
Modified: 8/14/2020
I’ve been using the “First Coast Service Options fee schedule look-up” for Part B -- what do par fee, nonpar fee, and limiting charge mean?
Modified: 8/5/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
LCD resources FAQ
Modified: 9/16/2020
Review answer pertaining to local coverage determinations (LCDs) and how to find available resources.
LCD status and proposed LCD comments FAQ
Modified: 7/29/2020
Review answer pertaining to local coverage determinations (LCDs) and the status of proposed LCDs.
MBI Lookup FAQ
Modified: 8/13/2020
Learn how easy it is to search for a beneficiary's Medicare Beneficiary Identifier (MBI) in SPOT.
MFA device for multiple users FAQ
Modified: 7/31/2020
MFA device registration FAQ
Modified: 7/31/2020
MFA device registration FAQ
Modified: 7/31/2020
MFA passcode to multiple devices FAQ
Modified: 7/31/2020
MM10550 changes for skilled nursing facililty (SNF) ambulance transport billing
Modified: 9/24/2020
Question regarding changes made to consolidated billing for ambulance transport for skilled nursing facility residents according to transmittal MM10550.
MSP claim rejection FAQ
Modified: 8/6/2020
Medicare Advantage plan FAQ
Modified: 7/10/2020
Medicare replacement FAQ
Modified: 8/4/2020
Medicare secondary payer (MSP) FAQ
Modified: 10/1/2020
Medicare secondary payer and VA FAQ
Modified: 8/1/2020
Questions and answers pertaining to Medicare secondary payer claims.
Modifier 24 and Medicare FAQ
Modified: 8/4/2020
Modifier 24 FAQ #1
Multi-practice group FAQs
Modified: 8/17/2020
Multifactor authentication and SPOT registration FAQ
Modified: 8/1/2020
Multiple hospitals FAQ
Modified: 9/9/2020
Multiple letters received FAQ
Modified: 8/17/2020
N264 FAQ
Modified: 8/18/2020
[SE1011, CR 6417]
No CBR data available FAQ
Modified: 8/28/2020
No E/M code suggested FAQ
Modified: 10/1/2020
OLT catalog FAQ
Modified: 10/12/2020
OLT registration FAQ
Modified: 8/22/2020
Obtain a previously issued PTAN
Modified: 8/20/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Only one initial service covered on admission to hospital
Modified: 10/2/2020
E/M FAQ question number 13
Opt-out providers wishing to order/refer FAQ
Modified: 9/9/2020
Order of same day critical care FAQ
Modified: 10/7/2020
E/M FAQ regarding Critical care
Out-of-state surgery with post-op in-state FAQ
Modified: 8/6/2020
Modifier 24 FAQ #5
Overlap HHEH FAQ
Modified: 9/19/2020
Overlap SNF FAQ
Modified: 9/6/2020
Overlap assistance FAQ
Modified: 10/24/2020
Overlap how to identify other facility FAQ
Modified: 8/27/2020
Overlapping DOS FAQ
Modified: 8/27/2020
PR 49
Modified: 8/27/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Past, family and social history
Modified: 8/20/2020
Submitted in response to E/M inquiries from providers
Plan Coverage FAQ
Modified: 8/28/2020
Plan of care signature or treatment FAQ
Modified: 8/17/2020
Question and answer pertaining to rehabilitation services and plan of care signatures in a CORF/ORF.
Pneumococcal and influenza virus vaccine administration FAQ
Modified: 8/21/2020
This FAQ discusses how to search for payment information for pneumococcal and influenza virus vaccine administration. [Medicare Claims Processing Manual, Chapter 18]
Post-operative follow-up visit FAQ
Modified: 7/10/2020
Modifier 24 FAQ #3
Pre-operative visit within global period FAQ
Modified: 8/6/2020
Modifier 24 FAQ #2
Profile change FAQ
Modified: 8/13/2020
Provider enrollment application types
Modified: 8/3/2020
Question and answer pertaining to Medicare enrollment applications.
Provider enrollment mailing address
Modified: 8/3/2020
Question and answer pertaining to Internet-based PECOS.
Provider enrollment, chain, and ownership system (PECOS)
Modified: 8/25/2020
Questions and answers pertaining to Part A provider enrollment issues, including electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Provider moved to different state
Modified: 9/9/2020
Question and answer pertaining to providers that need to enroll in a different state using Internet-based PECOS.
Providers employed by government health care programs FAQ
Modified: 8/12/2020
[SE 1011]
RIDP credit impact FAQ
Modified: 7/30/2020
RIDP data submission FAQ
Modified: 7/30/2020
RTP reason code 12206 FAQ
Modified: 10/24/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30912 FAQ
Modified: 8/7/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30940 FAQ
Modified: 10/2/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30949 FAQ
Modified: 8/27/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30960 FAQ
Modified: 10/2/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 32400 to 32404 FAQ
Modified: 8/7/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims. [First Coast's Education Action Team]
RTP reason code 34931 FAQ
Modified: 8/27/2020
[First Coast Provider Outreach and Education]
RTP reason code 37096 FAQ
Modified: 9/19/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 37544 FAQ
Modified: 10/24/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 38119 FAQ
Modified: 8/27/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason codes 153XX to 154XX FAQ
Modified: 8/7/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reason code CO 144 FAQ
Modified: 9/18/2020
Question and answer pertaining to CARC CO 144
Reason codes for denied claims FAQ
Modified: 10/7/2020
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Recertification deadline FAQ
Modified: 9/28/2020
Questions and answers for community mental health centers and hospitals pertaining to the Medicare partial hospitalization program benefit.
Recording ambulance mileage
Modified: 9/24/2020
FAQ regarding recording of ambulance mileage
Referring or consulting physician FAQ
Modified: 8/13/2020
When responding to a CERT request for medical records, can records from a referring or consulting physician be included? [First Coast Provider Outreach and Education]
Reimbursement for CORF versus ORF FAQ
Modified: 9/22/2020
Reject reason code 34538 FAQ
Modified: 10/2/2020
Questions and answers pertaining to verifying beneficiary eligibility.
Reject reason code 39929 FAQ
Modified: 10/2/2020
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reject reason code C7010 FAQ
Modified: 10/2/2020
Questions and answers pertaining to hospice.
Reject reason code U5061 FAQ
Modified: 10/8/2020
Questions and answers pertaining to beneficiary eligibility.
Reject reason code U5233 FAQ
Modified: 10/2/2020
Questions and answers pertaining to verifying beneficiary eligibility.
Reportable event
Modified: 8/28/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Reporting service facility location information FAQ
Modified: 8/4/2020
Question and answer about reporting service facility location information on a claim.
Request access to SPOT FAQ
Modified: 10/1/2020
Requesting a copy of certification letter
Modified: 9/18/2020
Question and answer pertaining to Medicare enrollment applications.
Restricted modifiers and procedure codes FAQ
Modified: 8/1/2020
Some modifiers and procedure codes are ineligible for clerical claim reopening on SPOT. This article provides a table listing those modifiers and procedure codes.
Resubmission of denied claim FAQ
Modified: 10/7/2020
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Return Unprocessable Claim (RUC) Reason Code CO 140 FAQ
Modified: 9/6/2020
[First Coast Education Action Team]
Return Unprocessable Claim (RUC) Reason Code CO 16 FAQ
Modified: 9/6/2020
[First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO 181 FAQ
Modified: 9/6/2020
[First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO109
Modified: 10/24/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Return unprocessable claim (RUC) reason code CO24 FAQ
Modified: 10/24/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Return unprocessable claim (RUC) reason code CO4 FAQ
Modified: 8/27/2020
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors. [First Coast Education Action Team]
Revalidation
Modified: 8/28/2020
Question and answer pertaining to revalidation requests.
Revalidation mailing FAQ
Modified: 8/18/2020
SPOT Help Desk FAQ
Modified: 7/25/2020
SPOT access issues for registered users FAQ
Modified: 9/5/2020
SPOT users who are receiving an error message upon login should follow these steps to resolve access issues.
SPOT error message after login FAQ
Modified: 8/5/2020
SPOT inactivity FAQ
Modified: 8/1/2020
If SPOT users become inactive, they risk losing their access. Be sure to log in to SPOT at least once every 30 days.
Search for billing and coding articles by diagnosis code FAQ
Modified: 7/29/2020
Review answer pertaining to billing and coding articles related to coverage determinations (LCDs) and how to search by diagnosis code.
Section 6 of the CMS-855R
Modified: 8/7/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Secure Documentation FAQ
Modified: 10/10/2020
Secure Documentation: Submission issue FAQ
Modified: 9/9/2020
Services included in critical care
Modified: 10/7/2020
E/M FAQ re services included in critical care
Should a claim be submitted as a cost outlier FAQ
Modified: 8/1/2020
Question and answer cost outlier claims.
Signature attestation statement FAQ
Modified: 9/22/2020
Signature log FAQ
Modified: 10/7/2020
Signature requirements FAQ
Modified: 8/20/2020
What are the signature requirements for medical documentation? Are there any exceptions? What will happen if I submit a medical record without arequired authentication?
Signature requirements for injections FAQ
Modified: 10/7/2020
Signature requirements for orders FAQ
Modified: 8/21/2020
Signature requirements for progress notes FAQ
Modified: 7/22/2020
Signed prescription/order FAQ
Modified: 8/26/2020
Sole owner but multiple locations FAQ
Modified: 8/7/2020
Sole proprietor versus a sole owner
Modified: 8/7/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Split and shared visits FAQ
Modified: 9/24/2020
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Split-shared visit or "incident to" FAQ
Modified: 8/6/2020
Modifier 24 FAQ #4
Submission of an EFT Agreement
Modified: 8/28/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Therapy evaluation FAQ
Modified: 8/17/2020
Training help FAQ
Modified: 8/13/2020
Two or more unrelated hospital visits on the same day FAQ
Modified: 9/19/2020
Updating provider enrollment information
Modified: 8/7/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Use of condition code 44 FAQ
Modified: 8/6/2020
Voluntary termination
Modified: 10/19/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
What actions do providers take to request an appeal of a Medicare overpayment for an MSP claim and stop the accounts receivable offset FAQ
Modified: 9/18/2020
Question and answer pertaining to what actions providers take to appeal an overpayment for an MSP claim and stop the AR offset.
What actions do providers take to request an appeal of a Medicare overpayment for an MSP claim and stop the accounts receivable offset FAQ
Modified: 9/30/2020
Question and answer pertaining to what actions providers take to appeal an overpayment for an MSP claim and stop the AR offset.
What are preventive benefits? FAQ
Modified: 7/10/2020
Review answer pertaining to preventive services.
What are the fields that were new on the 2015 MPFS and how are they used FAQ
Modified: 9/11/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
What are the timely filing guidelines FAQ
Modified: 8/27/2020
Question and answer pertaining to timely filing of claims.
What constitutes prescription drug management?
Modified: 10/1/2020
Submitted in response to provider E/M inquiries
What do I do if I have been overpaid because of a duplicate primary payment FAQ
Modified: 10/7/2020
Question and answer pertaining to a duplicate primary payment.
What do I do if I have been overpaid on a claim FAQ
Modified: 9/17/2020
Question and answer pertaining to an overpaid claim.
What do I do if I receive an overpayment letter FAQ
Modified: 9/11/2020
Question and answer pertaining to receiving an overpayment letter.
What form do providers use to notify Medicare of an MSP overpayment FAQ
Modified: 10/7/2020
Question and answer pertaining to what form providers use to notify Medicare of a MSP overpayment.
What happens if I bill more than the limiting charge?
Modified: 8/27/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
What happens when a redetermination or reconsideration appeal is requested FAQ
Modified: 9/13/2020
Question and answer pertaining to a redetermination or reconsideration appeal requested.
What if I do not agree with First Coast Service Options' determination? Does the TPE process change the current appeal process in place for Medicare providers?
Modified: 6/17/2020
TPE appeals
What if I have difficulty obtaining the medical record documentation?
Modified: 8/14/2020
What if an MSP refund is made voluntarily but the other insurer’s EOB is not sent with the payment FAQ
Modified: 9/11/2020
Question and answer pertaining to what if an MSP refund is made but the other insurer’s EOB is not sent with the payment.
What if an MSP refund is not made at the time the provider notifies Medicare of the DPP FAQ
Modified: 9/13/2020
Question and answer pertaining to what providers must do when refund is not made when notifying Medicare of a DPP.
What if the entire overpayment amount cannot be refunded at one time FAQ
Modified: 9/11/2020
Question and answer pertaining to an overpayment refund that cannot be made at one time.
What is MSP FAQ
Modified: 8/2/2020
Question and answer pertaining to what MSP is.
What is Targeted Probe and Educate (TPE)?
Modified: 9/17/2020
What is considered a relevant appeal FAQ
Modified: 8/4/2020
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
What is meant by merged records?
Modified: 9/24/2020
E/M FAQ question number 11
What is post-payment service-specific review?
Modified: 8/14/2020
What must providers do when a duplicate primary payment is received FAQ
Modified: 10/7/2020
Question and answer pertaining to what providers must do when a duplicate primary payment is received.
What notification will providers receive?
Modified: 8/14/2020
What notification will providers receive?
Modified: 6/17/2020
notification letter
What resources does First Coast use when conducting TPE reviews?
Modified: 6/17/2020
resources, policies, references
When do I need to have a registered MFA device in place FAQ
Modified: 7/31/2020
When is it appropriate to use occurrence code 47 when submitting an inpatient cost outlier claim?
Modified: 8/13/2020
Question and answer to cost outlier claims.
When should OSC 70 be used FAQ
Modified: 8/13/2020
Answer to the question of when OSC 70 should be used for cost outlier claims.
When to complete a new CMS-855
Modified: 8/25/2020
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
When to revalidate FAQ
Modified: 8/18/2020
Where are the Local Coverage Determination (LCDs), Local Coverage Articles, and National Coverage Determinations (NCDs) found?
Modified: 6/17/2020
LCD, NCD
Where can I find LCDs on First Coast's Medicare provider website?
Modified: 9/16/2020
Review answer pertaining to local coverage determinations (LCDs) and where they are published.
Where can I find fee schedules for my location and line of business?
Modified: 8/19/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fee schedules for specific services?
Modified: 8/7/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for chiropractic services?
Modified: 10/26/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for clinical laboratory services?
Modified: 9/2/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for end-stage renal disease (ESRD) services?
Modified: 10/27/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for hospital outpatient services?
Modified: 9/11/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for injectable drugs?
Modified: 9/11/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for mental health services?
Modified: 10/26/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for physician fee schedule services?
Modified: 8/5/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for podiatry services?
Modified: 10/26/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for rehabilitation services?
Modified: 10/26/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find information about the PC Pricer FAQ
Modified: 8/20/2020
Answer to the question can the PC Pricer be used to validate prospective payment system (PPS) payment amounts?
A: No. The payment amount the PC Pricer returns is an estimation of the final PPS payment. The PC Pricer was never intended to be used as a payment validation tool. The final payment may not be precise to how payments are determined in the Medicare claims processing system because other data is factored in the PC Pricer payment amount that is paid by Medicare via provider cost reports. A variance between actual Medicare payment and a PC Pricer estimate may exist as there is typically a three-month lag in quarterly updates to provider data.
Where can I obtain fee schedule policy indicators? For example, how can I find the global surgery days for a service? What about relative value units (RVUs) for a particular code?
Modified: 8/5/2020
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where do my additional documentation requests (ADR) letters and medical review (MR) correspondence go?
Modified: 6/17/2020
additional documentation request
Where to find detailed scenarios pertaining to observation care codes
Modified: 10/2/2020
E/M FAQ question number 17
Where to indicate referring or ordering provider information FAQ
Modified: 8/12/2020
Question and answer regarding the indication of referring provider information on claims.
Who is the BCRC and what is its purpose?
Modified: 9/4/2020
Question and answer pertaining to what the BCRC is.
‘SPOT eligibility reports’ FAQ
Modified: 7/31/2020
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.