One person called into the forum to enquire about a Q&A posted on the Web site of WPS Medicare, a Part B payer in four states, which asks whether an RN or LPN can perform “the entire annual wellness visit (AWV, G0438-G0439)." WPS responds on the website, “Yes, an RN or LPN can perform the visit; they need to be under the direct supervision of a doctor and the state license needs to allow for them to do all the components of the service. The caller enquired whether this is a general CMS policy or if it's applicable to WPS Medicare.
Remember, the LPN is not billing, reminding the caller that the visit would be billed under the physician's NPI as 'incident to'. However the caller still considered it 'odd' that an LPN could carry out an AWV since it is similar to an E/M service.
It is a different sort of service; there is not really any clinical judgment involved. It is a service which includes a sort of administrative steps; verifying that people have some preventive services done and things like that; and as such it's intended to be a collaborative service.
Remember that CMS doesn't have a national policy allowing LPNs and RNs to carry out AWVs; however representatives from the agency confirmed that it is within the rights of the individual MACs to make this determination.
Payment adjustments will soon be on the way
If you are looking for more money from your Medicare payer based on adjustments in the Affordable Care Act, CMS has a piece of advice for you – sit tight. The money that your MAC owes you is in process and contractors are working hard to get those adjustments out to you.
The agency erroneously processes 'hundreds of millions of claims' affected by the Affordable Care Act, and plans to reprocess those claims within the next two weeks; however the complete situation could take many months to resolve. It won't be something where everybody's claims will all of a sudden on one day start to be reprocessed. We have been working closely with our Medicare claims administration contractors to ensure all of these claims get reprocessed in an organized and deliberate manner so that we are not impending or jeopardizing new claims that come into the program.
Key: Don't resubmit your claims in an attempt to reprocess them at the accurate levels. If you resubmit claims, there is a very high possibility that those claims will be denied as duplicate claims. Allow the systems to do their work; it may not be as quickly as you would want; however let me assure you that we're trying our best so we can automatically reprocess as quickly as possible.
To add to it, do not submit a 'reopening' to your MAC regarding your claims as that could slow down your claim processing infinitely.
All claims cannot be reprocessed: Under some circumstances, your MAC won't reprocess the claim automatically. If the charge submitted on a claim is below the new rate, those affected providers will have to contact their Medicare contractor to ask for an adjustment. If your submitted charge is at or above the new rate, and I am primarily focused on physician claims paid under the Medicare Physician Fee Schedule…then those claims can easily be reprocessed, not a problem," said CMS's Stewart Streimer.
Your MAC won't send you a payment for every claim that it reprocesses. As an alternative, the MAC will aggregate your claims and will attach the remittance to your next payment.
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