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Here's CMS's full statement on claims denials involving providers billing the new annual wellness visit exam. CMS has investigated complaints that claims submitted by physicians for the new Annual Wellness Visit that went into effect on January 1, 2011, are being improperly denied, and has determined that this is not a national problem, but that there are a few contractors that have improperly denied these claims.
CMS has gone through an expedited rule making process to remove the voluntary end-of-life care provision from annual wellness visits (AWV). Part B News subscribers can read our full coverage of this story, but here is CMS's full explanation for why it is scrubbing end-of-life care from the services. 

"... we published the proposed rule entitled 'Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011.' In response to this publication, we received comments from health care providers, and others urging us to add voluntary advance care planning as a specified element of the definitions of both the 'first annual wellness visit' and the 'subsequent annual wellness visit.' The commenters stated that their recommendations were based upon a number of recent research studies, and the inclusion by the Medicare initial preventive physical examination (IPPE) provisions of a similar element in the existing IPPE benefit.

New York Times report says the Obama administration is removing the end-of-life care planning component to the new annual wellness visit (AWV) service.

The end-of-life plan, which is voluntary and requires patient consent, is just one of several parts to the service. The planning was added in the finalized 2011 Medicare Physician Fee Schedule, but it was not included in the proposed rule released in July. 

Robert Gibbs, the White House press secretary, said on Wednesday that this prevented the public from commenting on the provision during the rulemaking process.

CMS and HHS would not comment on the report Wednesday morning. Also, CMS had not issued any guidance on removing the component to the service.

Are you providing the annual wellness visit in 2011? If so, try using our initial annual wellness visit (AWV) patient encounter form. The AWV form was featured as Part B News' Tool of the Month in November. All Part B News subscribers have access to these tools for free and subscribers have permission to download the form and use it at their practice.

Subscribers can download the file by going to the Tool of the Month article for November and clicking on the "Download File" link.

You've got the details of annual wellness visit in writing, thanks to a CMS transmittal released Dec. 3. There are few surprises in the 35-page document, which is effective Jan. 1, the same day you can first start billing Medicare for this service. Transmittal 2109 does offer a full list of the remittance advice codes you'll see in the unhappy scenario that your annual wellness visit (AWV) gets denied.


While we have written extensively about the major requirements that could cause an early, edit-based denial of the AWV, knowing exactly how the error codes will read may help expedite your appeal efforts. Here's a breakdown, with special attention on the new codes (read more about CMS wellness visit transmittal) ...


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