Despite proper billing, payments for new annual wellness visits may not be paid until mid-to-late March.
At least three Medicare Administrative Contractors have been automatically denied already this year.
The affected claims had dates of service from Jan. 1 to Jan. 19.
They were likely denied by three MACs that have publicly announced their mistake, caused by claims processing software edits: First Coast, National Government Services and TrailBlazer.
NGS and TrailBlazer have not yet answered questions about the number of claims affected, or their estimate for reprocessing.
The impacted AWVs had a diagnosis code of V70.0 for routine general medical examination at a health care facility, though the code has been confirmed as valid, and should not cause a denial.
Other denials have been seen in E/M visits at that time, without modifier 25 of significant, separately identifiable E/M service.
Billing that uses modifier 25 is OK if the EM is being billed to treat an acute problem unrelated to the AWV.
Claims for visits that were billed after January 19 have been paid on time, and MACs have updated their claims processing software to avoid the error in the future.
Confusion over the AWV’s “effective date” of Jan. 1, 2011, and “implementation date” of April 4, 2011 also have been resolved.
Service has been payable from Jan. 1, so holding AWV claims is unnecessary, according to CMS.
We hope this information from ECP researchers help your billing department assure correct payment for claims. Please contact us if you have any questions.
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