Corporate Compliance

Transmittals/MLN Matters articles: CMS updates annual wellness visit transmittals, instructs on -GZ denials, and more

Medicare Update for Physician Services, March 3, 2011

CMS instructs on use of claims history for payment determinations

On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT, MAC) on the use of historical claims data when making a payment determination.

Effective date: March 25, 2011
Implementation date: March 25, 2011

View the transmittal.

CMS clarifies Alzheimer’s codes for mental health limitation

On February 25, CMS issued a transmittal to provide guidance on ICD-9 diagnosis codes that are Alzheimer’s related disorders for purposes of the outpatient mental health treatment limitation.

Effective date: March 25, 2011
Implementation date: March 25, 2011

View the transmittal.

CMS updates RAC underpayment instructions

On February 25, CMS issued a transmittal to update instructions related to processing of underpayments identified by the RACs.

Effective date: March 28, 2011
Implementation date: March 28, 2011

View the transmittal.

CMS replaces AWV transmittals

CMS rescinded and replaced two transmittals previously outlined in Medicare Update for Physician Services related to Medicare’s new annual wellness visit (AWV). The transmittals remove reference to the eliminated “advance care planning” element and make several other technical changes.

View the Claims Processing Manual transmittal.

View the Benefit Policy Manual transmittal.

CMS updates vaccine edits/payment instructions to prevent duplication

On February 11, CMS issued a transmittal to prevent duplicate payments for influenza virus and pneumococcal vaccine claims. The common working file has implemented a number of edits. The influenza virus code 90662 and pneumococcal vaccine code 90670 are being added to existing edits to prevent payment duplication.

Effective date: October 1, 2010
Implementation date: July 5, 2011

View the transmittal.

CMS instructs on primary care incentive program eligibility for new providers

On February 11, CMS issued a transmittal to amend the primary care incentive program to include participation for newly enrolled Medicare practitioners who do not have a prior two-year period claims history in which to determine eligibility. CMS subsequently replaced this transmittal to make corrections.

Effective date: July 1, 2011
Implementation date: July 5, 2011

View the corrected transmittal.

CMS instructs on -GZ denials

On February 4, CMS issued two transmittals to require contractors to automatically deny claim line(s) items submitted with a -GZ modifier. The GZ modifier indicates that an ABN was not issued to the beneficiary and signifies that the provider expects denial due to a lack of medical necessity based on an informed knowledge of Medicare policy. CMS instructs contractors not to perform complex medical review on claim line(s) items submitted with a -GZ modifier.

Effective date: July 1, 2011
Implementation date: July 5, 2011

View the Claims Processing Manual transmittal.

View the Program Integrity Manual transmittal.

View a related MLN Matters article.

CMS replaces transmittals

CMS replaced a transmittal previously outlined in Medicare Update for Physician Services.

MLN Matters articles

CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare Update for Physician Services.

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