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CMS said in an April 13 provider call that to bill advance care planning (ACP) without a preventive service, you need to show the service is “relevant to the patient’s disease state,” which would seem to mean it requires a diagnosis code.

CMS' new FAQs on advance care planning (ACP) contain some clarifications for which providers have been waiting, including guidance on how time should be counted and how frequently the service may be billed.

You’ve barely had time to process the new material in the 2012 Physician Fee Schedule final rule, but some of your peers are already blasting CMS for making annual wellness visits (AWVs) tougher to bill. The new component to the AWV is called the health risk assessment (HRA). Problem is, the AWV was already confusing to patients because it’s too restricting, includes no physical exam and is different from what patients and providers are used to as far as a “physical,” one angry caller told CMS during the agency’s latest open door call Nov. 7.

Get ready for an influx of new Medicare beneficiaries as the Medicare Open Enrollment Period starts. This year, the period begins earlier on Oct. 15 and will last seven weeks, through Dec. 7. A major new wrinkle this year are CMS-published star ratings for Medicare Advantage (MA) plans. “This year CMS is highlighting plans that have achieved an overall quality rating of 5 stars with a high performer or ‘gold star’ icon so people with Medicare can easily find high quality plans,” the agency said in an Oct. 12 press release.

Image from www.phreesia.comOne of your biggest opportunities for new revenue in 2011 and beyond is Medicare’s new annual wellness visit (AWV). One of the biggest obstacles to billing the AWV quickly and efficiently has been finding the right form for the visit, which is unlike a regular physical. Now some vendors are catching on and offering ways to cut physician time by digitizing the new encounter form needed to bill the AWV under Medicare guidelines.


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