Wiki Anthem Audit??

[Shannonbeth79]

Has anyone else received the notice from Anthem of the recent audit dating back years ago to recoup payments on the Q0091 codes when billed with an annual preventive code (i.e. 99386)?? Our office bills to match CMS guidelines and Q0091 is permitted outside of the G0438/G0439 as long as the patient meets medical criteria. Anthem is stating it's inclusive and now they're wanting to take back thousands of dollars. Anyone else aware of this? The letter says it's a state wide audit in CA so I imagine other offices will be receiving the notice as well. Looking for insight from other coders. Thank you.

 

[tmerickson]

Yes, I just heard from the IMA that Idaho BC is doing the same thing. There is supposed to be an updated policy explaining this, but I have been unable to find it on their website. I even put in an email to our local provider rep a few days ago, and havne't heard back. But, yes, they are going to take back up to 2010. Lame, huh?!