November 2011 Client Newsletter

Medicare Provider Revalidation

“All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (section 6401a). Providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.Do NOT submit your revalidation until you are notified to do so by your MAC. You will receive a notice to revalidate between now and March 2013.”Be advised that you/we only have 60 days from the date of the letter to submit the revalidation application – and non-physicians will be charged $505. Failure to submit within 60 days results in stopping your Medicare payments. Payment can be made online and is required before the application can be done on PECOS.

PROLIA

If you plan to bill Prolia, please let Rich know in advance so we can set up certain bill fields to contain the required data for payment. We will also update your charge form. Until January 1st when a new Prolia specific code will be available, you will bill the unclassified code (we will provide that info to you) plus the regular injection code (not a vaccine code). Since this is specifically used to treat osteoporosis, be sure to “checkmark” one of those diagnosis codes (e.g., 733.0X).

MEDICARE FLU SHOT FEES

Medicare released the Flu vaccine fees for Sept. 1, 2011 – August 31, 2012 on October 5th (great timing!):
Q2035 (Afluria): $11.543
Q2036 (Flulaval): $8.784
Q2037 (Fluvirin): $13.652
Q2038 (Fluzone): $13.306

ABN’s – THEY ARE CHANGING, AGAIN!

A new Medicare Advanced Beneficiary Notice (ABN) format has been released by CMS with an effective date 1/1/12 (just changed to 1/1/12 by CMS on 10/20). If you use an ABN, let Rich know ASAP and we will create an updated version. The 2008 version is not effective after 12/31/11.

BILLING INJECTION CODES 90471 & 90472

If you give 2 or more vaccine injections, you need to use both 90471 & 90472 (1 unit each). If you give 3 vaccine injections, then you would check both 90471 & 90472 and indicate 2 units on the charge form for 90472.

If the injection is for Tetanus for a Medicare patient, Medicare will pay as long as it is not a routine immunization - but we need to know if it is not a routine vaccination so we can bill correctly. We suggest that you indicate “injury” (or whatever is appropriate) on the charge form. We will do the rest. If it is routine and for a Medicare patient, in order to get paid (since it is not covered the patient is responsible) you will need the patient to sign a properly completed ABN.

If you are injecting allergens, use 95115 for 1, or 95117 for 2 or more. In this case, you do not use both codes.

ELECTRONIC CLAIMS AND PAYMENTS – 5010 FORMAT

On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB and our vendor are testing and do not anticipate any problem meeting this deadline.