You may have noticed recent denials from Palmetto GBA on your co-managed services and were left scratching your heads! We were too, at first! With the recent transition from Cahaba GBA to Palmetto GBA for our Medicare claims, we are uncovering some distinct differences between the two payers on how they would like claims filed. We sat down with our billing supervisor, Cyndee Coley, to get her thoughts. Here are the main takeaways: One example of the changes we recently discovered relates to how we file claims for services that are co-managed. In the past, the co-managing physician charges were filed with the surgical procedure code and modifier 55 to indicate post-op services only. This hasn't changed, but the new item for us all is that the date of service should match the actual date of surgery and not the date for which post-op services are assumed. Also, you will need to include a notation of the number of post-op days on your claim. The placement of this note depends on your practice management system but the note should correspond to Item 19 of the CMS-1500 claim form. For example, if you assume care at the one-day post-op visit then you are providing 90-day care. If you assume care after the one-week post-op then it will be 83 days (90-7). For full details on this change, CLICK HERE! If you have any questions with regard to Palmetto GBA and need assistance, please give us a call at (205) 943-4600.
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August 2019
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