Even though CMS originally suspended RVUs for this code, you'll now find an update.
In case your Medicaid provider is sending back your developmental screening claims and marking them "denied," there's a powerful new tool that can help you combat those zero-reimbursement situations for error-free medical coding.
Issue Lies in Testing vs. Screening Difference
Although most yearly CPT manual updates have the potential to help your practice considerably, others can cut your income to a halt. Unfortunately, that's been the case for a lot of pediatric practices that have been thwarted by the latest adjustment to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form).
Owing to the fact that this code was earlier referred to as a developmental "testing" code in the CPT manual, reimbursement was under no circumstances an issue for it. However, since a lot of Medicaid payers don't pay for "screening," some practices had to fight their payers for hours over the denial of these services. To control this issue, CMS released an "Informational Bulletin" on Dec. 28 that advises how to collect for these services.
As per the bulletin, a lot of State Medicaid agencies have developed fee schedules based upon Medicare billing codes and associated relative value units. Since Medicare does not pay for screening or preventive services…CMS changed the active status of code 96110 and did not take account of associated value units in the 2012 Medicare Resource Based Relative Value Scale physician fee schedule (PFS).
This change stemmed a lot of questions and potentially unintended consequences for other payers. CMS maintains that it wants to be clear that Medicaid and other private payers will be able to carry on using code 96110 although it is a statutorily non-covered service under Medicare. In addition, a lot of State Medicaid programs rely upon Medicare-published relative value units, including those related with code 96110 in the CPT manual.
Owing to this confusion, CMS announced that Medicare will update its 2012 Fee Schedule to signify the 2012 payment rate for 96110, which is 0.28 RVUs. The code will be noted status "N," demonstrating that code 96110 in the CPT manual is a non-covered service for Medicare payers. It must be recognized and covered by other payers, including Medicaid.
Source Code :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/medicaid-96110-use-this-tool-to-fight-medicaid-denials-for-developmental-screening-109560-article
Use CMS Letter as Your Appeal Tool
In case your Medicaid or private payer is following the original 2012 CMS directive to assign zero RVUs to 96110, you'll require to appeal any denials based on that wrong value assignment.
Along with your appeal letter, you must also include a copy of CMS's clarification, which evidently states the new RVUs for 96110.
In case your Medicaid provider is sending back your developmental screening claims and marking them "denied," there's a powerful new tool that can help you combat those zero-reimbursement situations for error-free medical coding.
Issue Lies in Testing vs. Screening Difference
Although most yearly CPT manual updates have the potential to help your practice considerably, others can cut your income to a halt. Unfortunately, that's been the case for a lot of pediatric practices that have been thwarted by the latest adjustment to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form).
Owing to the fact that this code was earlier referred to as a developmental "testing" code in the CPT manual, reimbursement was under no circumstances an issue for it. However, since a lot of Medicaid payers don't pay for "screening," some practices had to fight their payers for hours over the denial of these services. To control this issue, CMS released an "Informational Bulletin" on Dec. 28 that advises how to collect for these services.
As per the bulletin, a lot of State Medicaid agencies have developed fee schedules based upon Medicare billing codes and associated relative value units. Since Medicare does not pay for screening or preventive services…CMS changed the active status of code 96110 and did not take account of associated value units in the 2012 Medicare Resource Based Relative Value Scale physician fee schedule (PFS).
This change stemmed a lot of questions and potentially unintended consequences for other payers. CMS maintains that it wants to be clear that Medicaid and other private payers will be able to carry on using code 96110 although it is a statutorily non-covered service under Medicare. In addition, a lot of State Medicaid programs rely upon Medicare-published relative value units, including those related with code 96110 in the CPT manual.
Owing to this confusion, CMS announced that Medicare will update its 2012 Fee Schedule to signify the 2012 payment rate for 96110, which is 0.28 RVUs. The code will be noted status "N," demonstrating that code 96110 in the CPT manual is a non-covered service for Medicare payers. It must be recognized and covered by other payers, including Medicaid.
Source Code :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/medicaid-96110-use-this-tool-to-fight-medicaid-denials-for-developmental-screening-109560-article
Use CMS Letter as Your Appeal Tool
In case your Medicaid or private payer is following the original 2012 CMS directive to assign zero RVUs to 96110, you'll require to appeal any denials based on that wrong value assignment.
Along with your appeal letter, you must also include a copy of CMS's clarification, which evidently states the new RVUs for 96110.
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