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Wiki Palmetto denying PA claims

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HMJ

HMJ

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Pfafftown, NC
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Is anyone having problems with Palmetto not paying claims billed by PA? We've recently gone from Cigna to Palmetto as our MAC and they are denying inpatient & outpatient procedures billed by our PA's stating, "Medicare does not pay for this service when performed by a provider of this type."
Any help would be greatly appreciated.
 
There are some procedures that Medicare puts restrictions on as to the level of the provider, such as PA or NP or MD. you should be able to get a list of these and the restrictions.
 
We use encoder pro and if it states the CPT is allowed by a PA, we print the encoder confirmation and include the OP notes with the appeal and it usually works. If the encoder states not allowed it could result in a w/o.
 
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