Medicare Billing Updates Effective January 1, 2022

Date: 01/18/22

The Centers for Medicare and Medicaid (CMS) have released several billing changes and updates for various Medicare services that take effect on January 1, 2022. We want to make you aware of how these changes will impact your billing activities with us in 2022.

 

COVID-19 Vaccination Claims

·         Effective January 1, 2022, providers submit Medicare claims for COVID-19 vaccines and their administration directly to Wellcare for payment.

·         Previously, COVID-19 vaccination claims were submitted directly to Medicare Fee-for-Service. For dates of service January 1, 20222 and after, Wellcare will process and adjudicate all COVID-19 vaccination claims for its Medicare members.

·         We will reimburse the rates as they are established by CMS and our state regulators in accordance with provider contract terms for COVID-19 vaccine payments.

 

New/Modifications to the Place of Service (POS) Codes for Telehealth Services

·         Effective for dates of service January 1, 2022 and after, CMS is revising the description of POS code 02 and adding POS code 10 for telehealth services to meet the overall industry needs.

o    POS 02: Telehealth Provided Other than in Patient’s Home

§  Patient is not located in their home when receiving health services or health related services through telecommunication technology.

o    POS 10: Telehealth Provided in Patient’s Home

§  Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

·         We are working hard to configure our system and need until April 4, 2022 to finish the work.  As a result, claims adjudication for POS 10 will begin April 4, 2022 for dates of service January 1, 2022 and forward.

·         Please don’t hold your claims though; please submit so you avoid timely filing denials. If you submit a claim with POS 10 for a date of service prior to April 4, it will not be able to be reimbursed but you may later submit a corrected claim, which will be reimbursed.

·         For more information, please see CMS’ MLN Matters release.

Skilled Nursing Facility (SNF) Interim Billing Update

·         Effective January 1, 2022, we will accept and adjudicate interim bills from SNFs for our Medicare members.

·         No final bill is required.

Thank you for the excellent care you provide our Medicare members. If you have questions, please contact your Provider Engagement Specialist. If you need contact information for your assigned Provider Engagement Specialist, please email us at AzchProviderEngagement@azcompletehealth.com.