Several Medicare Administrative Contractors are reprocessing claims for annual wellness visits, and reviews are mixed on the claims that were considered wrongfully denied.

The problems were found at:

• Cahaba GBA (Alabama, Georgia, Mississippi and Tennessee) Unknown number of claims affected.
• First Coast Service Options (Florida, Puerto Rico, U.S. Virgin Islands) About 1,000 claims with estimated completion in March.
• National Government Services (Connecticut, Indiana, Michigan, New York) Fewer than 8,000 claims with February estimate to reprocess.
• TrailBlazer (Colorado, New Mexico, Oklahoma, Texas) Unknown number of claims.

Which claims are affected?
Only claims for AWVs from Jan. 1 to Jan. 19 are affected, but some providers report dates up to Jan. 27.

Why the denial?
Diagnosis codes and incomplete or invalid information are reasons cited, and some claims were denied, and others were paid partially, with instructions to collect the balance from patients.

Remember: The annual wellness visit is fully reimbursed by Medicare, and there is no patient copay, according to health reform law.

What now?
NGS admitted the problem and is correcting it. Other practices have had annual wellness visits paid the full, allowable amount, however.

We hope this information from ECP researchers help your billing department assure correct payment for claims. Please contact us if you have any questions.