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NGS advises Medicare wellness visit claims to be reprocessed
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National Government Services (NGS), Indiana’s Medicare carrier, advised that diagnosis code V70.0 (routine general medical examination at a health care facility) has been inappropriately issuing denials in the system. The amounts have been transferred to patient responsibility in error.

NGS is reprocessing the claims. You need not take any action at this time.

However, Jeri Biedenkopf, R.N., ISMA’s Medicare practice advisor, said, “It would be advisable for practices that have billed this code to track their denials to be certain you do eventually get paid for these claims.”

See the official message from The Centers for Medicare & Medicaid Services (CMS) on this issue below.

From National Government Services, Jan. 25, 2011:

Annual Wellness Visit Claims
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 7079 on December 3, 2010, which directed the implementation of Medicare’s annual wellness visit (AWV) under Section 4103 of the Affordable Care Act. Coverage and payment of the AWV were effective January 1, 2011.

Some providers billing for the AWV have included the “routine service” diagnosis code on their claims. Moreover, because Medicare does not pay for routine services, some contractors apply auto-deny edits whenever this “routine service” diagnosis is included on the claim. Consequently, some contractors are denying AWV claims when they should be paid.

CMS has directed contractors to not auto-deny claims for Healthcare Common Procedure Coding System (HCPCS) codes G0438 and G0439 when billed for an AWV in accordance with CR 7079. Based on this direction, National Government Services 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.

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