Artificial Intelligence Audits Are Happening Now
Healthcare providers are starting to see the first claim audits based on analysis and determinations made by artificial intelligence (AI). Although the technology is new, many of the issues remain…
Healthcare providers are starting to see the first claim audits based on analysis and determinations made by artificial intelligence (AI). Although the technology is new, many of the issues remain…
Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and,…
Stop worrying if your claims were denied, you still hold a chance as many carriers are reprocessing.
Almost a year ago, practices were told that Medicare will cover an annual wellness visit (AWV) for Part B beneficiaries effective Jan. 1 and last month, CMS announced the new codes for the AWVs. Everything seemed to look perfect until came the time for claims submissions and came the denials along with it.
The MACs may have hit a few speedbumps while processing the first of the AWV claims, but are attempting to get their systems rolling smoothly as January closes out for codes G0438 (Annual wellness visit, initial) and G0439 (Annual wellness visit, subsequent). We give you answers to several questions — straight from the MACs themselves — which may help you ensure that your claims go through smoothly.
Which Diagnosis Code Should You Use?
Several subscribers have told the Insider that they submitted their AWV claims using ICD-9 code V70.0 (Routine general medical examination at a health care facility), but faced immediate denials due to MACs claiming that this is the wrong diagnosis code.
It appears that those denials were the result of a computer glitch that made the AWV codes non-payable when billed with V70.0, but some payers have already fixed this problem.
National Government Services, a Part B payer in four states, sent out a notification on Jan. 25 stating that they “omitted the editing for diagnosis code V70.0 that is allowable with HCPCS codes G0438 and G0439, and claims that were initially denied are being reprocessed.
Pinnacle Business Solutions, a Part B MAC in two states, ran a notification on its Web site on Jan. 21 stating that a system error in the claims processing system incorrectly denied claims for G0438-G0439 between Jan. 1 and Jan 20. “A...
RACs are just another tool in the government’s arsenal to collect improper payments.
You’ve got so many compliance acronyms flying at you every day that you may not be able to differentiate your RAC from the OIG. Know these quick facts about RACs to stay better informed.
For more on the RAC program, visit www.cms.gov/rac.
@ Part B Insider. Editor: Torrey Kim, CPC
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Plus: Look for an increase in your DEXA scan reimbursement.
The bad news: Your carrier won’t be paying your claims using the conversion factor of $36.0846 anymore.
The good news: CMS is only changing the conversion factor by less than a penny, making it $36.0791, according to CMS Transmittal 700, issued on May 10. MACs will use this 2010 conversion factor to calculate your payments, but keep in mind that after May 31, you’re still due to face a 21 percent pay cut unless Congress intervenes. Keep an eye on the Insider for more information on whether Congress steps in...
Test your 2010 consultation coding understanding with these questions and answers.
Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by taking this three-question quiz and then...
Check your 2010 consultation coding savvy.
Find out if you’re set to properly code your physician’s consultation services this year by tackling three problems and their solutions.
Check With Your MAC for Guidance
When…
Related articles:Test your 2010 consultation coding understanding with these questions. Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by trying your hand at this question. Question: When a visit with a Medicare inpatient that would normally have been coded as a consultation does not [...] Related articles: