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Tag Archives: Annual
Annual Exam versus Office Visit
Hi,
I came across with this website:
https://www.aapc.com/blog/35667-icd-…d-well-visits/
and Im confused whether to code the annual exam with office visit and append it with 25 and get paid with the insurance? D
Please let me know your thoughts.
I came across with this website:
https://www.aapc.com/blog/35667-icd-…d-well-visits/
and Im confused whether to code the annual exam with office visit and append it with 25 and get paid with the insurance? D
Please let me know your thoughts.
Thanks
BCBS of Texas Annual Exam Denials
Is anyone else seeing an increase in Annual Exam denials when using modifier -25 showing separate and distinctive performed the same day. They pick and choose which ones they want to pay and then we have to appeal the rest. Sometimes we win, and sometimes we lose and then have to speak directly with CSR to prove clean and good claim for them to resubmit for additional review.
[Announcement] 2016 Annual Update of HCPCS Codes Use for SNF
October Quarterly Update to 2016 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
› Effective Date: October 1, 2016
› Implementation Date: October 3, 2016
Provider Types Affected: This information is intended for physicians, providers, and suppliers submitting claims to all Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries who are in a Part A Skilled Nursing Facility (SNF) stay.
Provider Action Needed: This information is based on Change Request (CR) 9688 updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS). Changes to Current Procedure Terminology (CPT)/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing in the “Medicare Claims Processing Manual,” Chapter 6, Section 20.6. Make sure your staffs are aware of these updates.
Background: The Centers for Medicare & Medicaid Services (CMS) periodically updates the lists of HCPCS codes that are excluded from the Consolidated Billing (CB) provision of the SNF PPS. Services excluded from SNF PPS and CB may be paid to providers, other than SNFs, for beneficiaries, even when in a SNF stay. Services not appearing on the exclusion lists submitted on claims to MACs, including Durable Medical Equipment MACs (DME).
Please note: “Shall” denotes a mandatory requirement, and “should” denotes an optional requirement.
Helpful Links
[PDF] Recurring Update Notification from CMS [Pub 100-04 Medicare Claims Processing)
[PDF] MLN Matters® Article [MM9688, CR 9688]
The Medical Management Institute – MMI – Medical Coding News & MMI Updates
2015 PQRS Feedback Reports & Annual QRURS- Available
2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRURs) are available.
- The PQRS Feedback Reports show your program year 2015 PQRS reporting results, including payment adjustment assessment for calendar year 2017
- The 2015 Annual QRURs show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier, as well as their 2017 Value Modifier payment adjustment
How to Access the Reports:
- An Enterprise Identity Management (EIDM) account with the appropriate role is required
- For PQRS Feedback Reports, view the User Guide and the PQRS Analysis and Payment webpage
- For Annual QRURs: visit the How to Obtain a QRUR webpage
Informal Review Process:
- Request an informal review of your 2015 PQRS results and/or 2017 Value Modifier calculation during the informal review period of September 26 through November 30, 2016
- 2015 PQRS: 2017 Negative Payment Adjustment – Informal Review Made Simple
- 2017 Value Modifier Informal Review Request Quick Reference
Helpdesk Information:
- For assistance with EIDM or PQRS Feedback Report content/data, contact the QualityNet Help Desk at [email protected] or 866-288-8912 (TTY 1-877-715- 6222) or from 7 am to 7 pm CT, Monday through Friday
- For assistance with QRURs, Value Modifier, or if you are having trouble accessing the PQRS Feedback Reports, contact the Physician Value Help Desk at [email protected] or 888-734-6433 (select option 3)
For more information, see the announcements for Access 2015 PQRS Feedback Reports and 2015 Annual QRURs Now and 2017 PQRS Negative Payment Adjustment Notification.
The Medical Management Institute – MMI – Medical Coding News & MMI Updates
2015 Annual QRURs Webcast – September 29
When: Wednesday, September 29 from 1:30 to 3 pm ET
Register Online: Click Here
To register or for more information, visit MLN Connects® Event Registration. Space may be limited, register early.
Description
In mid-September 2016, CMS will make 2015 Annual Quality and Resource Use Reports (QRURs) available to all group practices and solo practitioners nationwide. This event provides an overview of the report and explains how to interpret and use the information.
2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value-Based Payment Modifier (Value Modifier) and how the Value Modifier will be applied to physician payments. Learn more on the 2015 QRUR and 2017 Value Modifierwebpage. Visit How to Obtain a QRUR to access your report prior to the event.
CMS will use webcast technology for this event with audio streamed through your computer. Please note: if you are unable to stream audio through your computer, phone lines are available.
This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). Refer to the call detail page for more information.
Agenda
- Overview of the 2017 Value Modifier and 2015 QRUR
- How to access the 2015 Annual QRUR
- How to request an informal review of your 2017 Value Modifier
Register Online: Click Here
The Medical Management Institute – MMI – Medical Coding News & MMI Updates