AmeriChoice suspends recovery efforts...
As a result of feedback from providers and provider organizations, including TNAAP, AmeriChoice has suspended their recovery effort launched in late 2009. Providers should disregard notices of recovery from Johnson and Rountree (received in November or early December 2009) regarding new claims edits and prior claims payments.
On Tuesday, December 8, 2009, TNAAP (TN Chapter of the American Academy of Pediatrics) leaders met with representatives of TennCare and AmeriChoice to discuss the recent AmeriChoice/Johnson and Rountree recoupment project. TNAAP expressed the concerns of Tennessee pediatricians regarding lack of advance notification, lack of guidance about coding edits, and the retroactive nature of this project.
Based on the feedback from TNAAP, TMA and practices across the state, AmeriChoice will be overhauling its recoupment practices. Most importantly, practices should disregard the “mass recoupment packets” they received recently. It is unclear at this time if Americhoice will revise its methodology, timelines, etc. and re-run these edits or if they will cancel the claims review entirely. Pressure continues to have them completely cancel this project.
Pasted below are the highlights of the notification TNAAP anticipates receiving from Americhoice in writing shortly and summarizes the minimum of what they have agreed to as of Friday afternoon.
AmeriChoice will be suspending its current recovery effort. Next week, they will be sending letters to the network providers informing them of the following:
- Providers will not need to take any further action on the list of claims being recovered until they receive a new letter in early 2010.
- This 2010 mailing will contain a revised claims list for recovery. AmeriChoice is removing certain types of claims from the recovery including selected outpatient and inpatient Evaluation and Management services, subsequent immunization administration services when billed with the code for the initial service, and codes for preventive medicine visits.
- Providers will be notified of all the claims that AmeriChoice will no longer recover from its initial lists, and the remaining ones, if any, that are subject to recovery.
- The letters will specifically detail the process for appeals and submitting any corrected claims.
- With the new notice of claims to be sent in early 2010, providers will be provided 45 days to appeal from the date of the new letters.
- For any providers who have already submitted a check and/or corrected claims, AmeriChoice will reconcile repayment against the list of claims that are no longer being recovered against and reimburse the provider for the difference.
TNAAP leaders and the Pediatric Council will continue to monitor this situation closely. We will send out additional advisories as the situation warrants.