Divine Medical Billing Blog

Medicare E-Prescribing Incentive

Mylikia — Wed, 11 Jan 2012 16:44:48 +0000

So, the Medicare E-Prescribing Incentive topic has come up in so many conversations that I think it would be a great idea to just put it all out there.

Simply put, here is what you should know!

Penalty-

To avoid a 1% penalty each provider would have had to submit at least 10 claims with the G8553 CPT code for dates of service 01/01/2011 to 06/30/2011 by 07/21/2011. This pattern will repeat for 2012.

G8553 (At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system.)

Incentive-

To qualify for the incentive, there is no sign up. Each provider will need to submit 25 G8553 for the year. Billing 25 G8553 will make the provider exempt from penalty cuts for the next year.

View the links below for more information.

Incentive fact sheep- http://www.cms.gov/ERxIncentive/Downloads/erxintroeprescribing.pdf

Overview- http://www.cms.gov/ERxIncentive/03_How_To_Get_Started.asp#TopOfPage

Medicare Deductible for 2012

Mylikia — Wed, 21 Dec 2011 17:02:13 +0000

Effective January 1, 2012 the Medicare Part B deductible will be $140.

Billing Medicare for Preventive Visits Facts

Mylikia — Wed, 21 Dec 2011 16:22:59 +0000

Although Medicare does not cover routine physicals, there are two types of preventive visits that are payable. The first is the Initial Preventive Physical Examination (IPPE), also known as the “Welcome to Medicare Visit/Exam”. For the IPPE, the patient must be within their first 12 months of Medicare enrollment and have Medicare Part B. Medicare patients only get one IPPE visit in a lifetime. The IPPE is not subject to the Medicare deductible but the 20% coinsurance will apply.

The second type of “preventive visit” is the Annual Wellness Visit (AWV). The AWV can be performed once the Medicare patient is no longer in the first 12 months of Medicare Part B enrollment. This service cannot be performed within 12 months of an IPPE or a previous AWV service. There are two separate codes for AWV services. The first is G0438, which is for the first AWV service performed and can only be billed once in a lifetime. The second is G0439 and are subsequent AWV; these services can be billed annually. AWV services are not subject to the deductible or the 20% coinsurance. Medicare will pay the AWV visits at a 100% of the Medicare fee schedule.

Below is an example of how to bill Medicare “preventive services” for a patient with a Medicare Part B effective date of 01/01/2011.

Medicare Part B Effective Date: 01/01/2011

IPPE (G0402): 01/02/2011

AWV (G0438): 01/02/2012

AWV (G0439): 01/02/2013

AWV (G0439): 01/02/2014

FYI- You may also bill for the IPPE and AWV on the same day as a E&M visit with a 25 modifier.

More information about the AWV-https://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf

IPPE- https://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

Are you ready for Medicare’s new HIPPA 5010 billing standard?

Mylikia — Fri, 21 Oct 2011 20:21:15 +0000

The new Medicare billing standard 5010 must be implemented by 01/01/2012 for all covered entities. The change will prepare for the ICD-10 and improve claims receipts, editing, adjudications and more.

If you are billing electronically, check with you software vendor to make sure they are ready for the 01/01/2012 deadline.

For more information visit https://www.cms.gov/electronicbillingeditrans/18_5010d0.asp.

Seasonal Influenza Vaccines/Flu Shots Billing

admin — Fri, 22 Apr 2011 14:18:15 +0000

Now that the flu season is here, don’t forget to note the recent changes in billing Medicare for the flu vaccine.

To report the flu vaccine for Medicare patient use the following codes.

Medicare

Q2035 (Afluria)

Q2036 (Flulaval)

Q2037 (Fluvirin)

Q2038 (Fluzone)

Q2039 (Not Otherwise Specified)

Vaccine Codes

90655 ( Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use)

90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use)

90657 (Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use)

90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use)

When billing for the flu vaccine there are two parts. The first part to bill is the fee to inject the vaccine. The second is the fee for the actual vaccine. It should look as follows

Medicare

G0008 (Administration Code)

Q2036 (Choose appropriate vaccine code)

V04.81 (Diagnosis)

Other Insurance

90471 (Administration of vaccine)

90658 (Choose appropriate vaccine code)

V04.81 (Diagnosis)

For more information on Medicare flu vaccine billing requirements visit http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf .

This information was provided by Mylikia Ross Franklin, Certified Medical Billing Specialist/ Divine Medical Billing, Inc. To contact Mylikia, visit www.divinemedicalbilling.com or call (888) 292-8948.