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CMS released an updated 2011 conversion factor just days before the New Year, as the last 2010 Part B News newsletter was going to press. This left us with little time and space to write much detail about how the new conversion factor, $33.9764, will impact physician payments.

The conversion factor is just one component of the Medicare payment formula. So, you shouldn't be surprised that some payments, in particular E/M codes, increased in pay despite the 2011 conversion factor dropping 7% from the 2010 rate of $36.8729.  

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) ...

CMS is replacing the CPT code you've been accustomed to using for flu vaccines and is adding five new Q codes, with an enforcement date of Jan. 1, 2011. For dates of service starting Jan. 1, 90658 (flu vaccine, 3 years and older, $11.37) will no longer be payable. The five new Q codes are actually payable right now, and retroactively to Oct. 1, 2010. You may submit claims with these new codes on an individual basis or via roster billing. Here's a full list of the codes (read more on new Q codes for flu vaccines) ...

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