Palmetto GBA (www.PalmettoGBA.com), a wholly owned subsidiary of BlueCross BlueShield of South Carolina, is a leading provider of technical and administrative services for the federal government. Its principal business is providing administrative services for the Medicare program. The company has offices in South Carolina, Georgia, Ohio and Illinois. Palmetto GBA and BlueCross BlueShield of South Carolina are independent licensees of the Blue Cross and Blue Shield Association.
Video: Humana Made Medicare Easy
An explanation of Medicare
Part D is coverage for prescription drugs, and like Part C, the program is administered by private insurance companies. Part D plans have their own list of covered medicines, with a tiered pricing system. This means that some drugs, such as generics, may be in the lowest tier and have the lowest copayment. Drugs in the highest tiers would have the highest copayment. If you sign up for a Part D plan when you are first eligible you avoid paying a penalty. A penalty would be assessed if you don’t join when you were first eligible and you don’t have other drug coverage or don’t receive “Extra Help”. Beneficiaries with limited income and assets may qualify for “Extra Help” to help pay for prescription drugs. This program is administered through the Social Security program and Medicare. For more information, please visit www.SSA.gov/prescriptionhelp/.
Medicare issuing 2011 PQRS, eRx bonuses with “L” on RAs
For that reason, carrier accounting systems may place a negative sign before the dollar amount of a levy on a remittance notice. However, “in the case of PQRS and eRx incentive payments, the LE indicator represents an incentive payment and although the negative sign may appear on the remittance advice, the amount indicated does not represent a withhold or overpayment amount,” the Palmetto website continued. Both Medicare electronic and paper remittance advice provide additional coding to help practitioners identify PQRS and eRX incentive payments, the carrier noted.
Palmetto GBA: Erroneous Partial Episode Payment Adjustments on Certain Home Health Dual
If the state requesting a demand bill for the services within the original Medicare 60-day episode requires a new OASIS assessment, you should submit a RAP and submit the claim with condition code 20 as you would for any other demand bill situation. When Medicare receives the RAP for the demand billed episode it will cause a PEP adjustment to apply to the prior episode. If the final claim for the demand billed episode is later reviewed and found to be entirely non-covered, Medicare systems will automatically adjust the prior episode to restore the appropriate full episode payment.
Palmetto GBA Releases First Issue of Monthly Medicare Advisory
Palmetto GBA has released the first issue of the Medicare Advisory, which is is published monthly and applies to Jurisdiction 11 Home Health and Hospice (J11 HHH). Medicare home health and hospice providers are encouraged to review each issue of the Medicare Advisory to keep current about Medicare coverage and policy updates. The Medicare Advisory will also include information about upcoming education events and articles from various Palmetto GBA departments to assist providers when filing Medicare claims, updating their enrollment status or answering Medicare reimbursement or payment questions.
Compliance: 88305: Is 4 the New Prostate Biopsy Maximum for Medicare?
stdClass Object ( [term_id] => 207 [name] => Hot Coding Topics [slug] => hot-coding-topics [term_group] => 0 [term_order] => 0 [term_taxonomy_id] => 207 [taxonomy] => category [description] => The latest news [parent] => 0 [count] => 823 [cat_ID] => 207 [category_count] => 823 [category_description] => The latest news [cat_name] => Hot Coding Topics [category_nicename] => hot-coding-topics [category_parent] => 0 )  => stdClass Object ( [term_id] => 312 [name] => ICD-10 [slug] => icd-10 [term_group] => 0 [term_order] => 0 [term_taxonomy_id] => 4475 [taxonomy] => category [description] => All About ICD-10 [parent] => 0 [count] => 33 [cat_ID] => 312 [category_count] => 33 [category_description] => All About ICD-10 [cat_name] => ICD-10 [category_nicename] => icd-10 [category_parent] => 0 )  => stdClass Object ( [term_id] => 349 [name] => Provider News [slug] => provider-news [term_group] => 0 [term_order] => 2 [term_taxonomy_id] => 104 [taxonomy] => category [description] => Insurers, CMS, etc [parent] => 0 [count] => 271 [cat_ID] => 349 [category_count] => 271 [category_description] => Insurers, CMS, etc [cat_name] => Provider News [category_nicename] => provider-news [category_parent] => 0 )  => stdClass Object ( [term_id] => 102 [name] => Coding Challenge [slug] => coding-challenge [term_group] => 0 [term_order] => 3 [term_taxonomy_id] => 102 [taxonomy] => category [description] => Test Your Skills [parent] => 0 [count] => 227 [cat_ID] => 102 [category_count] => 227 [category_description] => Test Your Skills [cat_name] => Coding Challenge [category_nicename] => coding-challenge [category_parent] => 0 )  => stdClass Object ( [term_id] => 350 [name] => Toolkit [slug] => toolkit [term_group] => 0 [term_order] => 4 [term_taxonomy_id] => 110 [taxonomy] => category [description] => Coding & Billing Tools [parent] => 0 [count] => 133 [cat_ID] => 350 [category_count] => 133 [category_description] => Coding & Billing Tools [cat_name] => Toolkit [category_nicename] => toolkit [category_parent] => 0 ) ) –>
Palmetto, Medicare’s Biggest Carrier, Proposes to End Code Stacking for Molecular Clinical Laboratory Tests
Palmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics pPalmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics program (MolDx) have been proposed only for J1. If implemented, they would affect labs serving Medicare patients in California, Nevada, and Hawaii.
Is reimbursement for interpretation of prostate biopsies about to be slashed?
When this January 2012 NCCI update appeared, there was no contemporaneous publication by CMS or any of the Medicare contractors confirming its general adoption by the Medicare program. Moreover, there has been confusion as to whether NCCI intended the G codes to be utilized only where the biopsies were collected from a saturation biopsy technique, or regardless of the collection methodology. NCCI’s medical director has informed some private sources that the G codes should be used any time there are five or more prostate biopsy specimens, regardless of collection methodology. The August 7, 2012 Palmetto GBA policy adopts the NCCI update, explaining that the number of prostate biopsy specimens (regardless of collection technique) that can be reported with CPT Code 88305 is limited to four units per case, and the evaluation of five or more prostate biopsies must be reported using the G codes.
Medicare Compliance Review of West Florida Hospital in Pensacola
I do believe medicare/government is acting very unfairly to HHA in south florida. I am a United States Veteran of IOF 5. Money i saved for over 15 month plus my wife income here in the stated were put toward building our first business a HHA. After finally getting our NPI # we went and did individual marketing we finally strike a great company in Hiealeah FL which provided us we approximately 100 patients over a 1 year time period. To make the story short a physician was letting his PA sign for some of the referrals which he later said wasnt true after getting interviewed by the FBI. In the middle is our HHA we received a revokation letter for fraud, we had only been open for less than a year.. Medicare said we had billed over 2.8 millions which is impossible for 100 patient in less then a year based on our billing codes. beside our billing services were provided by one of the top billing candidate in miami. This is a nightmare, i havent been able to sleep propertly ever since, we rece
CMS Selects Palmetto GBA to Administer Medicare Claims in 3 States, 3 U.S. Territories
CMS is in the process of selecting 15 MACs to process claims for both Parts A and B of Medicare. The MACs will replace fiscal intermediaries, which currently process Part A claims, and carriers, which currently process Part B claims. Medicare Part A helps cover fees from hospitals, skilled nursing facilities and other institutional providers. Part B covers fees from physicians, laboratories and other practitioners. The Medicare Modernization Act of 2003 mandated creation of the MACs, which were established to increase efficiency and improve service by giving beneficiaries and providers a single point of contact for the Medicare program.