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Answers

36428
Modified: 10/4/2021
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: 10/12/2021
ADR response time FAQ
Modified: 10/5/2021
Access remittances via SPOT FAQ
Modified: 10/21/2021
Adding a provider to a group
Modified: 10/14/2021
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Address change notification
Modified: 11/11/2021
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: 9/6/2021
Adjustment and cancel claim data requirements FAQ
Modified: 10/7/2021
Advance beneficiary notice of noncoverage and ambulance services
Modified: 10/7/2021
Question relating to CMS guidelines regarding use of ABN in relation to ambulance services.
Ambulance claims and signature requirements
Modified: 10/7/2021
FAQ regarding signature requirements on ambulance claims
Amount and/or complexity of data – Office/Outpatient, 2021
Modified: 10/7/2021
The AMA – CPT E/M Office Revisions – Level of medical decision making table indicates *Each unique test, order, or document contributes to the combination of two or combination of three in Category 1.
Appeals FAQ -- Resubmission of denied claim
Modified: 11/11/2021
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Are there differences between the First Coast Part B fee schedule look-up, PDF files, and zipped text files?
Modified: 11/11/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Automatic use of lifetime reserve days FAQ
Modified: 10/1/2021
Avoiding RTP reason code 31255, 31256, 31257 FAQ
Modified: 10/29/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding RTP reason code N5052 FAQ
Modified: 10/3/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding reject reason code U5200 FAQ
Modified: 10/5/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Beneficiary eligibility and claim status FAQ
Modified: 10/8/2021
Beneficiary name field
Modified: 10/7/2021
This field is not required to use the score sheet. It was added to allow the user to enter the patient name, or any other patient-specific identifying information for printing and/or filing purposes only.
Billing PTA services ‘incident to’ physician services FAQ
Modified: 9/13/2021
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Billing modifier 59 FAQ
Modified: 10/6/2021
Questions and answers pertaining to specific modifiers.
Billing multiple modalities in same 15 minutes FAQ
Modified: 9/13/2021
Billing physician assistant services ‘incident to’ a doctor FAQ
Modified: 9/29/2021
Question and answer pertaining to services which can be billed "incident to" another provider's service.
CMS-1500 paper claim form FAQ
Modified: 10/15/2021
Question and answer referencing mailing address for CMS-1500 paper claim form.
CMS-460
Modified: 11/4/2021
Question and answer pertaining to Medicare enrollment applications.
Can I request early offset of a demanded debt FAQ
Modified: 10/7/2021
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: 10/7/2021
Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ
Modified: 9/13/2021
Questions and answers pertaining to Medicare Part B appeals and redeterminations.
Certification statement of the CMS-855
Modified: 11/12/2021
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 NPI
Modified: 11/11/2021
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Claim completion FAQ -- Accuracy of beneficiary information
Modified: 10/6/2021
Claim completion FAQ -- Entering POS on claims
Modified: 10/11/2021
Question and answer pertaining to entering place of service (POS) codes on claims.
Claim completion FAQ -- Indicating an anti-markup diagnostic service on a claim
Modified: 10/8/2021
Question and answer regarding the indication of an anti-markup diagnostic service on a claim.
Claim completion FAQ -- Indication of billing entity provider number
Modified: 10/5/2021
Question and answer pertaining to indicating provider numbers on claims.
Claim completion FAQ -- Indication of rendering physician billing number
Modified: 10/11/2021
Question and answer regarding the indication of rendering physician billing numbers on claims.
Claim completion FAQ -- Reporting service facility location information
Modified: 10/6/2021
Question and answer about reporting service facility location information on a claim.
Claim denial FAQ -- Claim denied for hospice
Modified: 11/22/2021
Claim reopening vs adjustment FAQ
Modified: 10/11/2021
Claim reopening: Accessing the claim FAQ
Modified: 10/20/2021
Claim reopening: Request types FAQ
Modified: 10/15/2021
Claim submission FAQ -- What are the timely filing guidelines?
Modified: 10/5/2021
Question and answer pertaining to timely filing of claims.
Claims overlap FAQ -- Home health episode overlap
Modified: 10/5/2021
Claims overlap FAQ -- Hospice and Medicare Advantage
Modified: 10/6/2021
Claims overlap FAQ -- Hospice overlaps inpatient stay
Modified: 10/6/2021
Claims overlap FAQ -- Request for assistance
Modified: 10/5/2021
Claims overlap FAQ -- SNF overlap
Modified: 10/6/2021
Claims overlap FAQ -- Steps to identify impacted claims
Modified: 10/6/2021
Claims overlap FAQ -- What is a claim overlap?
Modified: 10/5/2021
Coding mileage for ambulance transport FAQ
Modified: 11/25/2021
Questions and answers pertaining to ambulance services.
Common reason for adjusting and reopening claims FAQ
Modified: 10/29/2021
Compatibility view and other causes of reopening errors - FAQ
Modified: 10/20/2021
Denial reason code CO 50/PR 50 FAQ
Modified: 10/7/2021
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 CO 97 FAQ
Modified: 10/29/2021
[First Coast Education Action Team]
Denial reason code CO B9 FAQ
Modified: 10/22/2021
[First Coast Education Action Team]
Denial reason code CO/PR B7 FAQ
Modified: 10/22/2021
[First Coast Education Action Team]
Denial reason code CO22 FAQ
Modified: 10/29/2021
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: 9/24/2021
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: 10/5/2021
Question and answer pertaining to ANSI code OA-18.
Denial reason code PR 170 FAQ
Modified: 10/22/2021
[First Coast Education Action Team]
Determining the provider’s legal name
Modified: 11/11/2021
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: 10/26/2021
Review answer pertaining to local coverage determinations (LCDs) and national coverage determinations.
Difference between ‘ordering/referring provider’ and ‘billing provider’ FAQ
Modified: 11/4/2021
Digitally sign applications
Modified: 9/21/2021
Documentation for Puerto Rico providers
Modified: 9/21/2021
Duplicate reject/return to provider (RTP) reason code FAQ
Modified: 10/29/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
E/M FAQ -- 1995 Examination Guidelines
Modified: 10/12/2021
This based on E/M FAQs submitted by providers.
E/M FAQ -- Complete review of system (ROS)
Modified: 11/11/2021
Submitted in response to E/M inquiries from providers
E/M FAQ -- Determining further work-up under number of diagnoses
Modified: 10/11/2021
Submitted in response to provider E/M inquiries
E/M FAQ -- Determining overall risk for medical decision-making
Modified: 10/4/2021
Submitted in response to provider E/M inquiries
E/M FAQ -- History of Present Illness (HPI) and negative responses
Modified: 10/1/2021
Submitted in response to provider E/M inquiries
E/M FAQ -- How does drug therapy differ from drug management?
Modified: 10/5/2021
Submitted in response to provider E/M inquiries
E/M FAQ -- Past, family and/or social history (PFSH)
Modified: 10/11/2021
Submitted in response to E/M inquiries from providers
E/M FAQ -- What constitutes prescription drug management?
Modified: 10/1/2021
Submitted in response to provider E/M inquiries
E/M FAQ -- documentation of allergies
Modified: 10/1/2021
Submitted in response to provider E/M inquiries
E/M Worksheet -- Documentation support FAQ
Modified: 10/8/2021
EM FAQ -- Prescription drug management
Modified: 10/1/2021
Submitted in response to provider E/M inquiries
Effective date and retrospective billing
Modified: 11/12/2021
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Eligibility FAQ -- Medicare replacement plans
Modified: 10/11/2021
Eligibility for QMB beneficiary's FAQ
Modified: 10/21/2021
Eligibility requirements for ordering/referring providers FAQ
Modified: 11/9/2021
[CR 6417]
FAQ Negative Reimbursement (Deductible/Coinsurance)
Modified: 9/13/2021
Fastest way to find a list of active LCDs FAQ
Modified: 10/27/2021
Review answer pertaining to local coverage determinations (LCDs) and the fastest way to find active LCDs.
Federal sequestration payment reductions FAQs
Modified: 11/2/2021
Questions and answers pertaining to the 2% reduction in Medicare payments due to federal sequestration.
Fee schedules for specific services -- Part A
Modified: 10/29/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Fees for newly developed injections or innovative lab tests FAQ
Modified: 10/20/2021
Find out about changing LCDs FAQ
Modified: 10/26/2021
Review answer pertaining to local coverage determinations (LCDs) and how to find out about new and changes to existing LCDs.
GY modifier and dual diagnosis requirement on ambulance claims
Modified: 9/9/2021
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: 10/4/2021
Modifier 24 FAQ #6
Guidelines selection FAQ
Modified: 10/7/2021
Hospital visits and incident to provisions FAQ
Modified: 9/9/2021
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: 11/11/2020
How can I determine my locality?
Modified: 10/29/2021
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: 11/11/2020
How do I submit my EDI application using SPOT?
Modified: 10/21/2021
How do I submit my medical record documentation?
Modified: 10/12/2021
return documentation, medical records
How do I submit my medical records documentation?
Modified: 11/11/2020
How do I suppress claims that are in a 'T' (returned to provider) status location in direct data entry (DDE)?
Modified: 10/7/2021
How do providers determine when Medicare is the secondary payer FAQ
Modified: 10/13/2021
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: 11/11/2020
How do providers prepare documentation for submission?
Modified: 10/12/2021
return documentation, medical records
How do providers receive education?
Modified: 11/11/2020
How is a Medicare secondary payment determined FAQ
Modified: 10/13/2021
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 IDM accounts vs. SPOT profiles FAQ
Modified: 10/20/2021
How to complete a CMS-855 form
Modified: 9/28/2021
Question and answer pertaining to Internet-based PECOS.
How to join a First Coast webinar FAQ
Modified: 11/6/2021
How to login to SPOT FAQ
Modified: 10/21/2021
How to participate in a First Coast webinar FAQ
Modified: 11/6/2021
How to register for SPOT
Modified: 10/15/2021
How will I be notified of my TPE review results?
Modified: 6/17/2020
review results
How will the provider receive the ADRs?
Modified: 11/11/2020
IDM: Account sharing forbidden FAQ
Modified: 10/21/2021
IDM: Forgot Password/User ID FAQ
Modified: 10/21/2021
IDM: View/Modify Profile FAQ
Modified: 10/21/2021
ILT classes FAQ
Modified: 9/18/2021
ILT registration FAQ
Modified: 9/18/2021
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: 10/4/2021
Inpatient admit prior to entitlement FAQ
Modified: 10/7/2021
Only changed the year date to 2020 in the example
Inpatient hospital entitlement changes FAQ
Modified: 10/1/2021
Interval history FAQ
Modified: 11/26/2021
Is there a timetable available to help determine if a claim meets the criteria as cost outlier?
Modified: 9/29/2021
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: 11/11/2020
I’ve been using First Coast's fee schedule look-up for Part B -- what do par fee, nonpar fee, and limiting charge mean?
Modified: 11/2/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
LCD resources FAQ
Modified: 10/26/2021
Review answer pertaining to local coverage determinations (LCDs) and how to find available resources.
LCD status and proposed LCD comments FAQ
Modified: 10/27/2021
Review answer pertaining to local coverage determinations (LCDs) and the status of proposed LCDs.
MBI Lookup FAQ
Modified: 10/20/2021
Learn how easy it is to search for a beneficiary's Medicare Beneficiary Identifier (MBI) in SPOT.
MFA device for multiple users FAQ
Modified: 10/21/2021
MFA device registration FAQ
Modified: 10/21/2021
MFA device registration FAQ
Modified: 10/21/2021
MFA passcode to multiple devices FAQ
Modified: 10/21/2021
MM10550 changes for skilled nursing facililty (SNF) ambulance transport billing
Modified: 11/25/2021
Question regarding changes made to consolidated billing for ambulance transport for skilled nursing facility residents according to transmittal MM10550.
MSP claim rejection FAQ
Modified: 10/4/2021
Medicare secondary payer (MSP) FAQ
Modified: 10/21/2021
Medicare secondary payer and VA FAQ
Modified: 10/10/2021
Questions and answers pertaining to Medicare secondary payer claims.
Modifier FAQ -- Billing modifier 50
Modified: 10/6/2021
Questions and answers pertaining to specific modifiers.
Modifier FAQ -- Billing modifier 79
Modified: 10/6/2021
Questions and answers pertaining to specific modifiers.
Modifier FAQ -- Pre-operative visit within global period
Modified: 11/11/2021
Modifier 24 FAQ #2
Multifactor authentication and SPOT registration FAQ
Modified: 3/11/2021
No CBR data available FAQ
Modified: 10/20/2021
OLT catalog FAQ
Modified: 10/7/2021
OLT registration FAQ
Modified: 11/19/2021
Obtain a previously issued PTAN
Modified: 11/11/2021
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: 9/9/2021
E/M FAQ question number 13
Opt-out providers wishing to order/refer FAQ
Modified: 11/4/2021
Ordering provider enrollment
Modified: 9/21/2021
PECOS assistance
Modified: 9/21/2021
PR 49
Modified: 10/22/2021
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.
Plan Coverage FAQ
Modified: 10/21/2021
Profile change FAQ
Modified: 11/19/2021
Prolonged services – Office/Outpatient, 2021
Modified: 10/7/2021
The worksheet will only provide a suggested code for the E/M level of service. A note will populate alerting you that the service may qualify for additional prolonged services with a link to the prolonged service information.
Provider enrollment application types
Modified: 10/26/2021
Question and answer pertaining to Medicare enrollment applications.
Provider enrollment mailing address
Modified: 10/26/2021
Question and answer pertaining to Internet-based PECOS.
Provider enrollment, chain, and ownership system (PECOS)
Modified: 9/15/2021
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: 11/12/2021
Question and answer pertaining to providers that need to enroll in a different state using Internet-based PECOS.
Provider specialty
Modified: 9/21/2021
RIDP credit impact FAQ
Modified: 10/21/2021
RIDP data submission FAQ
Modified: 10/21/2021
RTP reason code 12206 FAQ
Modified: 11/22/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30912 FAQ
Modified: 10/6/2021
RTP reason code 30949 FAQ
Modified: 10/4/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30960 FAQ
Modified: 10/5/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 32400 to 32404 FAQ
Modified: 10/10/2021
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: 10/1/2021
[First Coast Provider Outreach and Education]
RTP reason code 37096 FAQ
Modified: 9/6/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason codes 153XX to 154XX FAQ
Modified: 9/24/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reason code CO 144 FAQ
Modified: 10/4/2021
Question and answer pertaining to CARC CO 144
Referring or consulting physician FAQ
Modified: 9/24/2021
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: 9/13/2021
Reject reason code 34538 FAQ
Modified: 11/29/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Reject reason code 34540 FAQ
Modified: 10/4/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Reject reason code 39929 FAQ
Modified: 10/4/2021
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reject reason code C7010 FAQ
Modified: 9/6/2021
Questions and answers pertaining to hospice.
Reject reason code U5233 FAQ
Modified: 10/5/2021
Questions and answers pertaining to verifying beneficiary eligibility.
Request access to SPOT FAQ
Modified: 10/21/2021
Requesting a copy of certification letter
Modified: 10/4/2021
Question and answer pertaining to Medicare enrollment applications.
Restricted codes for claim reopenings FAQ
Modified: 9/7/2021
Some modifiers, procedure codes, and denial codes are ineligible for clerical claim reopenings in SPOT. This article provides specifics.
Return Unprocessable Claim (RUC) Reason Code CO 140 FAQ
Modified: 10/6/2021
Corrected punctuation. 1 apostrophe added [First Coast Education Action Team]
Return Unprocessable Claim (RUC) Reason Code CO 16 FAQ
Modified: 10/11/2021
Change from URL to the title SE18006. Another punctuation errors were corrected. [First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO 181 FAQ
Modified: 10/1/2021
[First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO109
Modified: 8/15/2021
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: 11/7/2021
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: 10/22/2021
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]
SPOT Help Desk FAQ
Modified: 10/21/2021
SPOT access issues for registered users FAQ
Modified: 10/21/2021
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: 10/21/2021
SPOT inactivity FAQ
Modified: 10/15/2021
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: 10/26/2021
Review answer pertaining to billing and coding articles related to coverage determinations (LCDs) and how to search by diagnosis code.
Secure Documentation FAQ
Modified: 10/21/2021
Secure Documentation: Submission issue FAQ
Modified: 10/20/2021
Should a claim be submitted as a cost outlier FAQ
Modified: 9/29/2021
Question and answer cost outlier claims.
Signature attestation statement FAQ
Modified: 9/13/2021
Signature requirements FAQ
Modified: 10/4/2021
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: 10/7/2021
Signature requirements for orders FAQ
Modified: 9/9/2021
Sole owner but multiple locations FAQ
Modified: 11/4/2021
Submitting application before effective date
Modified: 9/21/2021
Time and MDM – Office/Outpatient, 2021
Modified: 10/7/2021
It is suggested to score both the time and medical decision making to allow billing of the highest scoring component.
Time – multiple separate entries – Office/Outpatient, 2021
Modified: 10/7/2021
The worksheet allows for multiple start and end times to be entered. The worksheet will calculate the total time. Be sure to click “add” to enter multiple start and end times.
Total time vs. start and end times – Office/Outpatient, 2021
Modified: 10/7/2021
The office/outpatient scoring for 2021 allows you to enter the total time or start and end times.
Training help FAQ
Modified: 11/19/2021
Updating provider enrollment information
Modified: 11/4/2021
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: 10/4/2021
Voluntary termination
Modified: 10/14/2021
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: 9/14/2021
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: 9/20/2021
Question and answer pertaining to what actions providers take to appeal an overpayment for an MSP claim and stop the AR offset.
What are the fields that were new on the 2015 MPFS and how are they used FAQ
Modified: 11/11/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
What do I do if I have been overpaid because of a duplicate primary payment FAQ
Modified: 10/9/2021
Question and answer pertaining to a duplicate primary payment.
What do I do if I have been overpaid on a claim FAQ
Modified: 10/9/2021
Question and answer pertaining to an overpaid claim.
What do I do if I receive an overpayment letter FAQ
Modified: 10/7/2021
Question and answer pertaining to receiving an overpayment letter.
What form do providers use to notify Medicare of an MSP overpayment FAQ
Modified: 10/9/2021
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: 10/1/2021
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: 11/6/2021
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: 11/11/2020
What if an MSP refund is made voluntarily but the other insurer’s EOB is not sent with the payment FAQ
Modified: 10/9/2021
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: 10/9/2021
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: 10/7/2021
Question and answer pertaining to an overpayment refund that cannot be made at one time.
What is MSP FAQ
Modified: 10/13/2021
Question and answer pertaining to what MSP is.
What is Targeted Probe and Educate (TPE)?
Modified: 9/17/2020
What is post-payment service-specific review?
Modified: 11/11/2020
What must providers do when a duplicate primary payment is received FAQ
Modified: 10/7/2021
Question and answer pertaining to what providers must do when a duplicate primary payment is received.
What notification will providers receive?
Modified: 6/17/2020
notification letter
What notification will providers receive?
Modified: 11/11/2020
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: 10/21/2021
When is it appropriate to use occurrence code 47 when submitting an inpatient cost outlier claim?
Modified: 9/29/2021
Question and answer to cost outlier claims.
When should OSC 70 be used FAQ
Modified: 9/29/2021
Answer to the question of when OSC 70 should be used for cost outlier claims.
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: 11/2/2021
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: 10/29/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fee schedules for specific services?
Modified: 10/29/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for chiropractic services?
Modified: 10/27/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for clinical laboratory services?
Modified: 11/11/2021
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: 10/4/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for hospital outpatient services?
Modified: 11/11/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for injectable drugs?
Modified: 11/11/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for mental health services?
Modified: 10/27/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for physician fee schedule services?
Modified: 10/29/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for podiatry services?
Modified: 10/27/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for rehabilitation services?
Modified: 10/27/2021
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
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: 11/2/2021
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 indicate referring or ordering provider information FAQ
Modified: 11/9/2021
Question and answer regarding the indication of referring provider information on claims.
Who is the BCRC and what is its purpose?
Modified: 10/13/2021
Question and answer pertaining to what the BCRC is.
Worksheet icons
Modified: 10/7/2021
The icons are clickable informational links to assist you with understanding the term used in the score sheet.
‘SPOT eligibility reports’ FAQ
Modified: 10/21/2021
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.