Medical Billing Forum

General Category => New! => Topic started by: Logeshkumar on July 28, 2016, 04:20:47 AM

Title: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Logeshkumar on July 28, 2016, 04:20:47 AM
Medicare denied stating " CO151 - Payment adjusted because the payer deems the information submitted does not support this many/frequency of services" . Please give some solutions.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Michele on July 28, 2016, 07:55:48 AM
There is no way to advise you without more information.  You didn't even provide what the service was??
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: kristin on July 28, 2016, 09:25:59 PM
This code is usually used when either too many units of something was billed for one DOS, or when something is only allowed to be billed X amount of times in a given time frame. Need more info, like Michele says.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Sriram_Sub on July 29, 2016, 06:56:33 AM
It is not easy, my friend. You have to be more specific when you are requesting for help. No one in this world can recommend a firm resolution without having more information about the Claim and the services.

I guess, you have not worked in denial management before, but have been asked to handle denials by yourself. If so, I pity you. We will help you for sure. But need more info.

Regards
Sriram
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: chandru_2k15 on December 07, 2016, 07:54:09 AM
You may check UOS (Unit of sevices) on CMS website for possible solutions to denials pertaining to number of units.

Thank You,
Chandru J.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: rhina on January 10, 2018, 12:36:24 PM
I got same denial from Medicare 151 :  Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Cpt J7322--units-96
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Michele on January 11, 2018, 08:26:21 AM
Did you check the LCD/NCD for J7322?  I'm showing that J7322 is a deleted code.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Sriram_Sub on January 11, 2018, 09:33:17 AM
I tried to attach a document that I downloaded from google but for some reason I could not attach. It said that J7322 1mg equals 24 billing units. Probably you should change your measurement for this HCPCS code from Units to MG so that you can bill 4 Mgs which equals 96 billing units. I don't know if your software allows you to specify unit measurement. If yes, you may try using 4 as the mg units which means 96 billing units.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: tperian on January 15, 2018, 12:23:22 PM
I am trying to bill G0439 and getting the same message.  The units equal 1 and it has been over a year since the last time it was filed.  Any other suggestions?
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: kristin on January 15, 2018, 03:40:26 PM
Was your office the last to file the AWV? Is it possible it was also recently billed by another office that you are not aware of?
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: tperian on January 16, 2018, 06:49:25 AM
That is entirely possible.  How do we avoid this since the patient wouldn't know that is what the other physician charged?  Do you suggest we recode the claim and refile it or would it be better to cut our loss?
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Sriram_Sub on January 16, 2018, 07:31:25 AM
If it is a scheduled appointment, you may verify benefits with the payer and see if your plan of Annual wellness care would be covered. By then, you would know if someone has already billed for that service during the same year.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: tperian on January 16, 2018, 08:28:12 AM
Thank you for your help.  Since the HPI states that the patient was here for his annual wellness check, i would not be able to re-code this visit as an E&M.  Correct?
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: Sriram_Sub on January 17, 2018, 09:10:02 AM
For the current charge, you may change the CPT and ICD code if the chart notes (by any chance) has been documented with some diagnosis other than Z00.00 or so. This way, we may justify that the patient was given a consultation for a problem and that it was not a AWV.

For your future AWV charges, I would suggest to have their eligibility verified so that the reps can advise if the patient is eligible to get a AWV consultation given for the year. Hope this helps.
Title: Re: Medicare - CO151 - Payment adjusted because the payer deems the information
Post by: tperian on January 17, 2018, 09:30:43 AM
It does.  thank you so much for your help.  Have a great day.