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Answers

'SPOT Eligibility Report' examplepdf file
Modified: 6/24/2019
The SPOT eligibility report is a snapshot of a beneficiary's eligibility profile based upon the dates of service queried.
1995 Examination guidelines
Modified: 9/1/2019
This based on E/M FAQs submitted by providers.
36428
Modified: 9/4/2019
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: 8/12/2019
ADR response time FAQ
Modified: 8/22/2019
Access remittances via SPOT FAQ
Modified: 9/2/2019
Accuracy of beneficiary information FAQ
Modified: 8/5/2019
Adding a provider to a group
Modified: 7/31/2019
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: 7/23/2019
Will FCSO’s medical review (MR) department request additional documentation from providers during the CERT process?
Additional records submission during appeals FAQ
Modified: 9/4/2019
Questions and answers pertaining to Medicare Part A appeals and redeterminations.
Address change notification
Modified: 9/4/2019
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: 8/15/2019
Adjustment and cancel claim data requirements FAQ
Modified: 8/2/2019
Advance Beneficiary Notice of Noncoverage and ambulance services
Modified: 8/24/2019
Question relating to CMS guidelines regarding use of ABN in relation to ambulance services.
Ambulance claims and signature requirements
Modified: 8/14/2019
FAQ regarding signature requirements on ambulance claims
Amount in controversy (AIC) FAQ
Modified: 8/27/2019
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Appeal rights for DRG change recommendation FAQ
Modified: 9/4/2019
Appeals FAQ
Modified: 9/19/2019
[First Coast Education Action Team]
Appeals outcome FAQ
Modified: 7/23/2019
Learn how to find the outcomes of your first-level appeals (redeterminations) in SPOT.
Application fee
Modified: 9/9/2019
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: 9/4/2019
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: 9/15/2019
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: 6/23/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
At what time and date does observation care begin?
Modified: 7/6/2019
E/M FAQ question number 17
Authentication questions FAQ
Modified: 9/3/2019
What is the minimum number of authentication questions that I am required to answer during EIDM (enterprise identity management system) registration?
Automatic use of lifetime reserve days FAQ
Modified: 7/21/2019
Avoidable CERT error FAQ
Modified: 8/2/2019
What is the most common, avoidable CERT error? How can it be avoided?
Avoiding RTP reason code 31255, 31256, 31257 FAQ
Modified: 8/8/2019
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding RTP reason code N5052 FAQ
Modified: 9/4/2019
Questions and answers pertaining to verifying beneficiary eligibility.
Avoiding reason code 76474 FAQ
Modified: 8/16/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Avoiding reject reason code U5200 FAQ
Modified: 9/4/2019
Questions and answers pertaining to verifying beneficiary eligibility.
Beneficiary eligibility and claim status FAQ
Modified: 8/5/2019
Billing PTA services ‘incident to’ physician services FAQ
Modified: 7/11/2019
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Billing modifier 50 FAQ
Modified: 6/20/2019
Questions and answers pertaining to specific modifiers.
Billing modifier 59 FAQ
Modified: 8/5/2019
Questions and answers pertaining to specific modifiers.
Billing modifier 79 FAQ
Modified: 7/29/2019
Questions and answers pertaining to specific modifiers.
Billing multiple modalities in same 15 minutes FAQ
Modified: 7/17/2019
Billing of separate, same-day critical care services
Modified: 9/1/2019
E/M FAQ re separate, same-day critical care services
Billing physician assistant services ‘incident to’ a doctor FAQ
Modified: 7/23/2019
Question and answer pertaining to services which can be billed "incident to" another provider's service.
CMS-1500 paper claim form FAQ
Modified: 7/12/2019
Question and answer referencing mailing address for CMS-1500 paper claim form.
CMS-460
Modified: 8/6/2019
Question and answer pertaining to Medicare enrollment applications.
CR 6417 overview FAQ
Modified: 8/16/2019
[SE1011, CR 6417]
Can I adjust a claim that has been denied, which is in a 'D' status location in direct data entry (DDE)?
Modified: 6/28/2019
Can I register more than once FAQ
Modified: 7/15/2019
Do I need to submit another Internal Revenue Service (IRS) document if I register another organization with the same legal business name and tax ID number?
Can I register more than one organization FAQ
Modified: 9/3/2019
If this is my first time registering in EIDM (enterprise identity management system) can I register more than one organization at a time?
Can I request early offset of a demanded debt FAQ
Modified: 8/22/2019
Question and answer pertaining to early offset of a demanded debt.
Can MAC deny access FAQ
Modified: 9/3/2019
What are reasons why a Medicare administrative contractor (MAC) would deny my request for access to the provider statistical and reimbursement report (PS&R) system?
Can a request for offset/recoupment be made at the same time I notify Medicare of an overpayment FAQ
Modified: 7/3/2019
Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ
Modified: 7/19/2019
Questions and answers pertaining to Medicare Part B appeals and redeterminations.
Can the MAC resolve registration issues FAQ
Modified: 8/29/2019
Does the Medicare administrative contractor (MAC) have the ability to track my EIDM (enterprise identity management system) registration process and to help me resolve registration issues?
Can the MAC send a PS&R report FAQ
Modified: 8/13/2019
If I am having difficulty registering and need my provider statistical & reimbursement (PS&R) reports quickly. Can the Medicare administrative contractor (MAC) send me the reports?
Certification statement of the CMS-855
Modified: 9/4/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Certification statement timeframe
Modified: 7/31/2019
This FAQ pertains to PECOS requirements for ordering or referring providers.
Change of address and Type 2 National Provider Identifier (NPI)
Modified: 9/3/2019
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: 9/9/2019
Question and answer pertaining to changing passwords in PECOS I&A.
Claim Reopening: Check status FAQ
Modified: 7/23/2019
Claim reopening vs adjustment FAQ
Modified: 7/18/2019
Claim reopening: Accessing the claim FAQ
Modified: 9/2/2019
Claim reopening: Request types FAQ
Modified: 7/23/2019
Claims overlap FAQ
Modified: 7/18/2019
Clinical psychologist -- enrollment application
Modified: 9/5/2019
Question and answer pertaining to Medicare enrollment application for clinical psychologists.
Coding mileage for ambulance transport FAQ
Modified: 8/14/2019
Questions and answers pertaining to ambulance services.
Coding mileage in the CMN FAQ
Modified: 7/24/2019
Questions and answers pertaining to ambulance services.
Common reason for adjusting and reopening claims FAQ
Modified: 8/15/2019
Compatibility view and other causes of reopening errors - FAQ
Modified: 9/2/2019
Contact person
Modified: 9/4/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Cost report contact person FAQ
Modified: 9/4/2019
Whom do I contact if I have questions about my cost report?
Cost report due FAQ
Modified: 9/3/2019
When is my cost report due?
Critical care and moment of crisis FAQ
Modified: 6/20/2019
E/M FAQ regarding Critical care
Critical care and separate E/M on same day FAQ
Modified: 7/29/2019
Date of service for ambulance provider claims
Modified: 8/14/2019
FAQ regarding recording of date of service of ambulance claims
Deductibles/Caps FAQ
Modified: 6/26/2019
Definition FAQ
Modified: 8/21/2019
Definition of new stable problem
Modified: 9/7/2019
Submitted in response to provider E/M inquiries
Delegating authority to sign CMS-855B applications
Modified: 9/3/2019
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: 9/9/2019
Question and answer pertaining to deleting applications in Internet-based PECOS.
Denial reason code CO 50/PR 50 FAQ
Modified: 9/14/2019
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: 8/8/2019
[First Coast Education Action Team]
Denial reason code CO B9 FAQ
Modified: 7/6/2019
[First Coast Education Action Team]
Denial reason code CO/PR B7 FAQ
Modified: 8/8/2019
[First Coast Education Action Team]
Denial reason code CO22 FAQ
Modified: 8/8/2019
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: 9/7/2019
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: 7/20/2019
Question and answer pertaining to ANSI code OA-18.
Denial reason code PR 170 FAQ
Modified: 9/4/2019
[First Coast Education Action Team]
Departmental appeals board (DAB) FAQ
Modified: 7/10/2019
Recovery Audit Contractor departmental appeals board
Determining overall risk for medical decision-making
Modified: 8/14/2019
Submitted in response to provider E/M inquiries
Determining the provider’s legal name
Modified: 9/4/2019
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: 8/30/2019
Review answer pertaining to local coverage determinations (LCDs) and national coverage determinations.
Difference between ‘ordering/referring provider’ and ‘billing provider’ FAQ
Modified: 8/16/2019
Documentation support FAQ
Modified: 7/30/2019
Documenting history component
Modified: 7/26/2019
Submitted in response to provider E/M inquiries and 2019 update to Federal Register
Does the billing physician need to document the time the patient spent in observation care, or the time the physician spent tending to the patient?
Modified: 7/17/2019
E/M FAQ re observation care time
Dual eligibility FAQ
Modified: 6/23/2019
Duplicate reject/return to provider (RTP) reason code FAQ
Modified: 8/8/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
EDI FAQ
Modified: 8/21/2019
EFT FAQ
Modified: 8/6/2019
EIDM documentation FAQ
Modified: 9/3/2019
Where can I obtain a complete list of the documentation required by the Centers for Medicare & Medicaid Services (CMS) for EIDM (enterprise identity management system) registration?
EIDM help desk FAQ
Modified: 8/12/2019
Why does the EIDM (enterprise identity management system) help desk always tell me to contact the Medicare administrative contractor (MAC)?
EIDM multiple facilities FAQ
Modified: 8/15/2019
I have one Tax Identification Number (TIN) number for multiple facilities. Can I register all of the facilities in EIDM (enterprise identity management system)?
EIDM registration for provider statistical and reimbursement report (PS&R) FAQ
Modified: 9/4/2019
If I only use the provider statistical and reimbursement (PS&R) reports once a year, do I still need to register in enterprise identity management system to CMS computer services (EIDM)?
EIDM responsibilities FAQ
Modified: 8/12/2019
What are the responsibilities of the EIDM help desk?
EIDM: Account sharing forbidden FAQ
Modified: 8/7/2019
EIDM: Account sharing forbidden FAQ
Modified: 6/26/2019
EIDM: Forgot Password/User ID FAQ
Modified: 7/3/2019
EIDM: View/Modify ‘My Profile’ FAQ
Modified: 8/14/2019
EIDM: View/Modify ‘My SPOT Access Profile’ FAQ
Modified: 9/11/2019
Effective date FAQ
Modified: 8/6/2019
Effective date and retrospective billing
Modified: 9/4/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Electronically file FAQ
Modified: 7/10/2019
What does it mean to file electronically?
Eligibility data variances between HETS and the CWF FAQ
Modified: 9/2/2019
Eligibility for QMB beneficiary's FAQ
Modified: 7/23/2019
Eligibility requirements for ordering/referring providers FAQ
Modified: 8/20/2019
[CR 6417]
Eligibility self-verification FAQ
Modified: 8/20/2019
[CR 6417]
Eligibility verification FAQ
Modified: 8/20/2019
[CR 6417]
Enrolling or changing information online
Modified: 9/3/2019
Question and answer pertaining to Internet-based PECOS.
Entering POS on claims FAQ
Modified: 7/10/2019
Question and answer pertaining to entering place of service (POS) codes on claims.
Extended repayment schedule FAQ
Modified: 9/3/2019
How do I request an extended repayment schedule for overpayments?
FAQ Negative Reimbursement (Deductible/Coinsurance)
Modified: 9/14/2019
FAQs on provider enrollment revalidation cycle 2 for Puerto Rico providers
Modified: 8/16/2019
Failure to submit cost report FAQ
Modified: 8/21/2019
What happens if I do not file my cost report timely?
Fastest way to find a list of active LCDs FAQ
Modified: 8/30/2019
Review answer pertaining to local coverage determinations (LCDs) and the fastest way to find active LCDs.
Federal sequestration payment reductions FAQs
Modified: 8/14/2019
Questions and answers pertaining to the 2-percent reduction in Medicare payments due to federal sequestration.
Find out about changing LCDs FAQ
Modified: 7/24/2019
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: 7/29/2019
Questions and answers pertaining to specific modifiers.
Forgot password FAQ
Modified: 9/5/2019
I have already registered in EIDM (enterprise identity management system), but I have forgotten my password, who should I contact to have it reset?
GY modifier and dual diagnosis requirement on ambulance claims
Modified: 8/30/2019
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: 8/5/2019
Modifier 24 FAQ #6
Good standing letter
Modified: 9/5/2019
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: 8/3/2019
Questions and answers pertaining to ambulance services.
Guidelines for reference to previous notes
Modified: 7/24/2019
Submitted in response to provider E/M question
Guidelines for use of an E/M questionnaire
Modified: 7/13/2019
Submitted in response to inquiries from providers
Guidelines regarding HPI and negative responses
Modified: 7/13/2019
Submitted in response to provider E/M inquiries
Guidelines regarding a complete ROS
Modified: 9/15/2019
Submitted in response to E/M inquiries from providers
Guidelines regarding as "self-limited or minor" problem
Modified: 7/13/2019
Submitted in response to provider E/M inquiries
Guidelines regarding designation of "old" or "new" problems
Modified: 7/13/2019
Submitted in response to E/M inquiries from providers
Guidelines regarding elements of History
Modified: 7/24/2019
Submitted in response to provider E/M inquiries
Guidelines regarding how allergies apply to History component
Modified: 7/13/2019
Submitted in response to provider E/M inquiries
Guidelines regarding prescription drug management
Modified: 9/7/2019
Submitted in response to provider E/M inquiries
Guidelines regarding review of old records
Modified: 7/13/2019
Submitted in response to provider inquiries re E/M guidelines.
Guidelines selection FAQ
Modified: 7/30/2019
HPI and acute/chronic diseases
Modified: 9/1/2019
Submitted in response to E/M inquiries from providers
Home office registration FAQ
Modified: 9/4/2019
If I am a home office that manages numerous facilities, do I need to register as an end user for each of the facilities in EIDM (enterprise identity management system)?
Home office registration FAQ
Modified: 8/16/2019
What is EUS?
Hospice denial FAQ
Modified: 6/20/2019
Hospice overlap & MA FAQ
Modified: 8/2/2019
Hospice overlaps inpatient stay FAQ
Modified: 7/11/2019
Hospital visits and incident to provisions FAQ
Modified: 9/15/2019
Question and answer pertaining to services which can be billed incident to another provider's service.
How can I determine my locality?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
How can I view check information in DDE?
Modified: 6/28/2019
How do I submit my EDI application using SPOT?
Modified: 7/30/2019
How do I suppress claims that are in a 'T' (returned to provider) status location in direct data entry (DDE)?
Modified: 6/28/2019
How do providers determine when Medicare is the secondary payer FAQ
Modified: 7/17/2019
Question and answer pertaining to how providers can determine when Medciare is the secondary payer. [CMS website]
How is a Medicare secondary payment determined FAQ
Modified: 8/22/2019
Question and answer pertaining to how Medicare secondary payment is determined.
How many EIDM accounts vs. SPOT profiles FAQ
Modified: 7/26/2019
How to complete a CMS-855 form
Modified: 9/3/2019
Question and answer pertaining to Internet-based PECOS.
How to determine further work-up under number of diagnoses
Modified: 9/6/2019
Submitted in response to provider E/M inquiries
How to join a First Coast webcast FAQ
Modified: 9/2/2019
How to login to SPOT FAQ
Modified: 9/2/2019
How to participate in a First Coast webcast FAQ
Modified: 7/12/2019
How to register for SPOT
Modified: 7/25/2019
I have access but I am not on pick list FAQ
Modified: 8/23/2019
I have access to the provider statistical and reimbursement report (PS&R) system, but I don’t see my provider number(s) on the pick list, who should I contact?
ILT classes FAQ
Modified: 8/3/2019
ILT registration FAQ
Modified: 7/25/2019
In the fee schedule lookup tool -- what do the question marks in the column headers mean?
Modified: 8/27/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Inactive periods FAQ
Modified: 7/11/2019
Indicating an anti-markup diagnostic service on a claim FAQ
Modified: 6/20/2019
Question and answer regarding the indication of an anti-markup diagnostic service on a claim.
Indication of billing entity provider number FAQ
Modified: 7/22/2019
Question and answer pertaining to indicating provider numbers on claims.
Indication of rendering physician billing number FAQ
Modified: 7/10/2019
Question and answer regarding the indication of rendering physician billing numbers on claims.
Inpatient admit prior to entitlement FAQ
Modified: 9/14/2019
Inpatient hospital entitlement changes FAQ
Modified: 9/4/2019
Interns and residents wishing to order/refer FAQ
Modified: 8/20/2019
[SE 1011]
Interval history FAQ
Modified: 7/30/2019
Introduction to modifiers FAQ
Modified: 8/5/2019
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: 7/21/2019
Answer to the question regarding a timetable for coding inpatient cost outlier claims.
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: 8/14/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
LCD resources FAQ
Modified: 7/24/2019
Review answer pertaining to local coverage determinations (LCDs) and how to find available resources.
LCD status and proposed LCD comments FAQ
Modified: 9/12/2019
Review answer pertaining to local coverage determinations (LCDs) and the status of proposed LCDs.
Listed system administrator FAQ
Modified: 8/14/2019
Do I need to have a person listed as a system administrator in the provider statistical and reimbursement report (PS&R) system?
Long registration time FAQ
Modified: 8/12/2019
Why does it take so long to register in EIDM (enterprise identity management system)?
Low or no utilization FAQ
Modified: 9/4/2019
What if my cost report reports is a low or no Medicare utilization?
MBI Lookup FAQ
Modified: 8/19/2019
Learn how easy it is to search for a beneficiary's Medicare Beneficiary Identifier (MBI) in SPOT.
MFA Symantec VIP software download FAQ
Modified: 8/2/2019
MFA device for multiple users FAQ
Modified: 8/2/2019
MFA device registration FAQ
Modified: 8/2/2019
MFA device registration FAQ
Modified: 8/2/2019
MFA passcode during login FAQ
Modified: 8/2/2019
MFA passcode for multiple work stations FAQ
Modified: 8/2/2019
MFA passcode to multiple devices FAQ
Modified: 8/2/2019
MM10550 changes for skilled nursing facililty (SNF) ambulance transport billing
Modified: 8/17/2019
Question regarding changes made to consolidated billing for ambulance transport for skilled nursing facility residents according to transmittal MM10550.
MSP claim rejection FAQ
Modified: 8/5/2019
Medicare Advantage plan FAQ
Modified: 7/10/2019
Medicare replacement FAQ
Modified: 7/29/2019
Medicare secondary payer (MSP) FAQ
Modified: 7/3/2019
Medicare secondary payer and VA FAQ
Modified: 7/21/2019
Questions and answers pertaining to Medicare secondary payer claims.
Modifier 24 and Medicare FAQ
Modified: 8/5/2019
Modifier 24 FAQ #1
More information for EIDM FAQ
Modified: 9/4/2019
Where can I obtain additional information related to EIDM (enterprise identity management system)?
More than one security official FAQ
Modified: 8/14/2019
We submit separate cost reports with the same tax identification number (TIN). Can we have more than one security official?
Multi-practice group FAQs
Modified: 8/21/2019
Multifactor authentication (MFA) frequently-asked questions
Modified: 7/24/2019
Multifactor authentication and SPOT registration FAQ
Modified: 8/2/2019
Multiple hospitals FAQ
Modified: 6/25/2019
Multiple letters received FAQ
Modified: 8/21/2019
N264 FAQ
Modified: 8/20/2019
[SE1011, CR 6417]
N265 FAQ
Modified: 8/20/2019
[SE1011, CR 6417]
No CBR data available FAQ
Modified: 9/2/2019
No E/M code suggested FAQ
Modified: 8/1/2019
No claims/payment information FAQ
Modified: 7/26/2019
No cost report requirement FAQ
Modified: 9/3/2019
Do I have to register in EIDM (enterprise identity management) if I am not required to file a cost report?
OLT catalog FAQ
Modified: 9/4/2019
OLT registration FAQ
Modified: 8/9/2019
Obtain PS&R report FAQ
Modified: 8/16/2019
I received my EIDM (enterprise identity management system) user ID; can I now obtain my provider statistical and reimbursement report (PS&R) reports via the Internet?
Obtain a previously issued PTAN
Modified: 9/3/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Obtaining payment information FAQ
Modified: 9/3/2019
How do I obtain a payment information summary for lump-sum adjustments, when preparing my cost report?
Only one initial service covered on admission to hospital
Modified: 9/15/2019
E/M FAQ question number 13
Opt-out providers wishing to order/refer FAQ
Modified: 9/9/2019
Order of same day critical care FAQ
Modified: 9/4/2019
E/M FAQ regarding Critical care
Organization is not in the pick list FAQ
Modified: 9/4/2019
What should I do if my organization is not shown in the pick list during the EIDM (enterprise identity management system) registration process?
Out-of-state surgery with post-op in-state FAQ
Modified: 8/7/2019
Modifier 24 FAQ #5
Overlap HHEH FAQ
Modified: 7/18/2019
Overlap SNF FAQ
Modified: 7/3/2019
Overlap assistance FAQ
Modified: 9/19/2019
Overlap how to identify other facility FAQ
Modified: 7/18/2019
Overlapping DOS FAQ
Modified: 7/18/2019
Overpayments FAQ
Modified: 8/14/2019
What do I do if I have an overpayment?
PR 49
Modified: 7/6/2019
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.
PS&R status check FAQ
Modified: 7/12/2019
I have made a request for provider statistical and reimbursement report (PS&R). Can the EIDM (enterprise identity management system) help desk check on the status of my request?
Past, family and social history
Modified: 7/24/2019
Submitted in response to E/M inquiries from providers
Plan Coverage FAQ
Modified: 9/2/2019
Plan of care signature or treatment FAQ
Modified: 7/11/2019
Question and answer pertaining to rehabilitation services and plan of care signatures in a CORF/ORF.
Pneumococcal and influenza virus vaccine administration FAQ
Modified: 9/1/2019
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: 7/29/2019
Modifier 24 FAQ #3
Pre-operative visit within global period FAQ
Modified: 8/5/2019
Modifier 24 FAQ #2
Preventive Service Eligibility FAQ
Modified: 8/2/2019
Profile change FAQ
Modified: 7/17/2019
Provider enrollment application types
Modified: 8/6/2019
Question and answer pertaining to Medicare enrollment applications.
Provider enrollment mailing address
Modified: 8/6/2019
Question and answer pertaining to Internet-based PECOS.
Provider enrollment, chain, and ownership system (PECOS)
Modified: 9/4/2019
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: 9/9/2019
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: 8/20/2019
[SE 1011]
Providers that do not belong on the pick list FAQ
Modified: 8/29/2019
I have access to the provider statistical and reimbursement report (PS&R) system but I am seeing providers on my pick list that do not belong to my organization. Whom do I contact to correct this problem?
RIDP credit impact FAQ
Modified: 8/2/2019
RIDP data submission FAQ
Modified: 8/2/2019
RIDP unsuccessful Experian proofing FAQ
Modified: 8/2/2019
RIDP unsuccessful online verification FAQ
Modified: 8/2/2019
RTP reason code 12206 FAQ
Modified: 9/4/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30912 FAQ
Modified: 9/4/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30940 FAQ
Modified: 8/24/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30949 FAQ
Modified: 7/20/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 30960 FAQ
Modified: 8/16/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 32400 to 32404 FAQ
Modified: 9/14/2019
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: 7/3/2019
[First Coast Provider Outreach and Education]
RTP reason code 37544 FAQ
Modified: 9/7/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason code 38119 FAQ
Modified: 7/20/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
RTP reason codes 153XX to 154XX FAQ
Modified: 9/4/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reason code CO 144 FAQ
Modified: 7/3/2019
Question and answer pertaining to CARC CO 144
Reason codes for denied claims FAQ
Modified: 9/13/2019
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Recertification deadline FAQ
Modified: 8/12/2019
Questions and answers for community mental health centers and hospitals pertaining to the Medicare partial hospitalization program benefit.
Recording ambulance mileage
Modified: 8/14/2019
FAQ regarding recording of ambulance mileage
Referring or consulting physician FAQ
Modified: 7/27/2019
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]
Register more than one provider with same legal name FAQ
Modified: 9/3/2019
If this is my first time registering in EIDM (enterprise identity management system) can I register more than one organization at a time?
Rehabilitation and therapy providers FAQ
Modified: 7/12/2019
Are comprehensive outpatient and rehabilitation facilities (CORF) or outpatient physical therapy providers (OPT) still required to file a cost report?
Reimbursement for CORF versus ORF FAQ
Modified: 7/23/2019
Reject reason code 34538 FAQ
Modified: 7/17/2019
Questions and answers pertaining to verifying beneficiary eligibility.
Reject reason code 39929 FAQ
Modified: 8/16/2019
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Reject reason code C7010 FAQ
Modified: 8/16/2019
Questions and answers pertaining to hospice.
Reject reason code U5061 FAQ
Modified: 8/24/2019
Questions and answers pertaining to beneficiary eligibility.
Reject reason code U5233 FAQ
Modified: 8/16/2019
Questions and answers pertaining to verifying beneficiary eligibility.
Reportable event
Modified: 9/5/2019
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: 7/16/2019
Question and answer about reporting service facility location information on a claim.
Request access to SPOT FAQ
Modified: 7/10/2019
Requesting a copy of certification letter
Modified: 7/15/2019
Question and answer pertaining to Medicare enrollment applications.
Restricted modifiers and procedure codes FAQ
Modified: 8/7/2019
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: 9/4/2019
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Return Unprocessable Claim (RUC) Reason Code CO 140 FAQ
Modified: 7/6/2019
[First Coast Education Action Team]
Return Unprocessable Claim (RUC) Reason Code CO 16 FAQ
Modified: 7/6/2019
[First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO 181 FAQ
Modified: 7/6/2019
[First Coast Education Action Team]
Return unprocessable claim (RUC) reason code CO109
Modified: 7/17/2019
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: 9/14/2019
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: 7/20/2019
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: 9/5/2019
Question and answer pertaining to revalidation requests.
Revalidation deadline FAQ
Modified: 8/21/2019
Revalidation mailing FAQ
Modified: 8/6/2019
SPOT Help Desk FAQ
Modified: 8/12/2019
SPOT Live Chat FAQ
Modified: 9/11/2019
SPOT access issues for registered users FAQ
Modified: 8/16/2019
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: 8/7/2019
SPOT inactivity FAQ
Modified: 8/2/2019
If SPOT users become inactive, they risk losing their access. Be sure to log in to SPOT at least once every 30 days.
SPOT session length FAQ
Modified: 8/7/2019
Search for LCD by diagnosis code FAQ
Modified: 8/30/2019
Review answer pertaining to local coverage determinations (LCDs) and how to search by diagnosis code.
Section 6 of the CMS-855R
Modified: 8/8/2019
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: 7/23/2019
Secure Documentation: Submission issue FAQ
Modified: 9/11/2019
Selections failed to print FAQ
Modified: 7/17/2019
Services included in critical care
Modified: 9/1/2019
E/M FAQ re services included in critical care
Should a claim be submitted as a cost outlier FAQ
Modified: 7/21/2019
Question and answer cost outlier claims.
Signature attestation statement FAQ
Modified: 7/23/2019
Signature log FAQ
Modified: 9/1/2019
Signature requirements FAQ
Modified: 7/27/2019
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: 9/1/2019
Signature requirements for orders FAQ
Modified: 8/2/2019
Signature requirements for progress notes FAQ
Modified: 7/6/2019
Signed prescription/order FAQ
Modified: 7/17/2019
Sole owner but multiple locations FAQ
Modified: 8/8/2019
Sole proprietor versus a sole owner
Modified: 8/8/2019
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: 9/15/2019
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Split-shared visit or "incident to" FAQ
Modified: 8/5/2019
Modifier 24 FAQ #4
Status of enrollment application
Modified: 8/8/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Submission of an EFT Agreement
Modified: 9/5/2019
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: 7/17/2019
Training help FAQ
Modified: 7/16/2019
Types of claims impacted by CR 6417 FAQ
Modified: 8/20/2019
[CR 6417]
Unable to get EIDM help FAQ
Modified: 9/4/2019
If the EIDM (enterprise identity management system) help desk is unable to resolve my registration issues, should I call the Medicare administrative contractor (MAC) or Centers for Medicare & Medicaid Services (CMS)?
Updating provider enrollment information
Modified: 8/8/2019
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: 8/5/2019
Variances in eligibility data FAQ
Modified: 6/23/2019
Verifying the QMB status of out-of-state beneficiaries
Modified: 6/19/2019
Find out how providers can verify the QMB status of a beneficiary who is out of state.
Voluntary termination
Modified: 7/31/2019
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Webcast presentation FAQ
Modified: 7/11/2019
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: 7/15/2019
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: 7/3/2019
Review answer pertaining to preventive services.
What are the fields that were new on the 2015 MPFS and how are they used FAQ
Modified: 6/23/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
What are the timely filing guidelines FAQ
Modified: 7/13/2019
Question and answer pertaining to timely filing of claims.
What constitutes prescription drug management?
Modified: 9/1/2019
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: 9/12/2019
Question and answer pertaining to a duplicate primary payment.
What do I do if I have been overpaid on a claim FAQ
Modified: 8/22/2019
Question and answer pertaining to an overpaid claim.
What do I do if I receive an overpayment letter FAQ
Modified: 8/22/2019
Question and answer pertaining to receiving an overpayment letter.
What form do providers use to notify Medicare of an MSP overpayment FAQ
Modified: 8/22/2019
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: 7/31/2019
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: 9/12/2019
Question and answer pertaining to a redetermination or reconsideration appeal requested.
What if an MSP refund is made voluntarily but the other insurer’s EOB is not sent with the payment FAQ
Modified: 8/22/2019
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: 9/12/2019
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: 8/22/2019
Question and answer pertaining to an overpayment refund that cannot be made at one time.
What is MSP FAQ
Modified: 7/3/2019
Question and answer pertaining to what MSP is.
What is Remote Identity Proofing FAQ
Modified: 8/2/2019
What is considered a relevant appeal FAQ
Modified: 7/16/2019
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
What is meant by merged records?
Modified: 8/14/2019
E/M FAQ question number 11
What must providers do when a duplicate primary payment is received FAQ
Modified: 7/3/2019
Question and answer pertaining to what providers must do when a duplicate primary payment is received.
What to include FAQ
Modified: 8/21/2019
When do I need to have a registered MFA device in place FAQ
Modified: 8/7/2019
When is it appropriate to use occurrence code 47 when submitting an inpatient cost outlier claim?
Modified: 7/21/2019
Question and answer to cost outlier claims.
When should OSC 70 be used FAQ
Modified: 7/21/2019
Answer to the question of when OSC 70 should be used for cost outlier claims.
When to complete a new CMS-855
Modified: 9/4/2019
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: 8/21/2019
Where can I find LCDs on First Coast's Medicare provider website?
Modified: 7/24/2019
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: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for acute inpatient services?
Modified: 8/14/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for ambulance services?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for ambulatory surgical center (ASC) services?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for chiropractic services?
Modified: 8/2/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for clinical laboratory services?
Modified: 9/16/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for durable medical equipment, prosthetics, orthotics, and supplies?
Modified: 9/1/2019
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: 8/3/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for hospital outpatient services?
Modified: 6/23/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for injectable drugs?
Modified: 6/23/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for inpatient psychiatric facility services?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for inpatient rehabilitation facility services?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for long-term care hospital services?
Modified: 9/1/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for mental health services?
Modified: 7/31/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for physician fee schedule services?
Modified: 8/14/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for podiatry services?
Modified: 8/2/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for rehabilitation services?
Modified: 8/5/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where can I find fees for skilled nursing facility (SNF) services?
Modified: 8/27/2019
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: 8/14/2019
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Where do I send the cost report FAQ
Modified: 7/8/2019
Where do I send my completed cost report?
Where to find detailed scenarios pertaining to observation care codes
Modified: 9/6/2019
E/M FAQ question number 17
Where to indicate referring or ordering provider information FAQ
Modified: 8/20/2019
Question and answer regarding the indication of referring provider information on claims.
Where will it be sent FAQ
Modified: 8/21/2019
Who is the BCRC and what is its purpose?
Modified: 7/24/2019
Question and answer pertaining to what the BCRC is.
‘SPOT eligibility reports’ FAQ
Modified: 9/2/2019
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.