You schedule a patient's first Medicare annual wellness visit (AWV). The patient comes into your organization, or perhaps you meet via telehealth. You furnish the AWV, seemingly checking all the boxes necessary to deliver this critical yearly appointment that helps prevent illness and get your organization paid. And yet a few weeks after submitting your claim to Medicare for the service, it's denied. The reason: You incorrectly used HCPCS code G0438. Denials can lead to increased days in accounts receivable, write-off rates, and overall cost to collect, among other headaches. A study revealed thatmany AWVs conducted and billed may fail to meet compliance requirements set forth by CMS, which can trigger denials or more serious ramifications. If you want to better ensure that your annual wellness visit claims are not denied, you must know how to properly code them. In this piece, we provide you with the HCPCS codes you need to use for annual wellness visits. We also share guidance that should help reduce the likelihood that your organization will experience denials associated with this service and another service commonly associated with the AWV that may trip you up: the initial preventive physician examination (IPPE).
The importance of using preventive medicine to improve the health and ultimately lives of patients is widely recognized. The Medicare annual wellness visit (AWV) plays an important role in helping Medicare beneficiaries stay current with their health and take actions that can prevent illness and reduce risk. An essential piece of the process required to ensure offering and providing preventive services remains financially viable is for organizations to complete the Medicare annual wellness visit reimbursement coding process accurately. Doing so can help ensure providers receive their earned reimbursements and protect them against possible penalties they might incur from failed coding audits. We know some organizations struggle with meeting compliance requirements set forth by the Centers for Medicare & Medicaid Services. In this blog post, we take a look at what's required for compliant AWV coding. While this is by no means a comprehensive guide to Medicare annual wellness visit reimbursement, it provides organizations with information that can assist them in avoiding some of the most common AWV coding mistakes that result in rejected claims, lost revenue, or failed audits — all of which can be mitigated when using Prevounce software.
A Kaiser Health News (KHN) article tells the story of Medicare beneficiary Beverly Dunn. She scheduled her annual physical exam, believing that Medicare would cover the checkup. Then Dunn received the bill and quickly learned the shocking piece of information many patients discover: Medicare does not cover annual physical exams.
There were a number of significant changes affecting the delivery and billing of remote care management in the 2023 Medicare Physician Fee Schedule (PFS) final rule, as we covered in this webinar. One of them was the Centers for Medicare & Medicaid Services (CMS) finalizing the coverage for chronic pain management and treatment services (CPM) — new services that were introduced in the 2023 Medicare PFS proposed rule.
Medicare's annual wellness visit (AWV) has had a rocky ride since its introduction in 2010 and started in 2011 as part of the Affordable Care Act. As with many big healthcare changes, the new service was met with resistance and steeped in confusion, leading to terribly slow uptake and obstacles that still unjustly plague the service more than a decade later. When Medicare beneficiaries do not receive their AWV, this is not only a disservice to these patients, but practices and the healthcare system as a whole lose out on important and impactful benefits.
As a practitioner, you understand how beneficial a cardiovascular risk assessment is for your patients. While assessing and treating your patient's cardiac risk factors is beneficial, it can eat up one of your most valuable resources: time. Finding time-saving tools that you can trust and rely on forcompliance and accuracy is almost as important as performing the risk assessment itself.
I'm sure we're all aware of the American way of life — the one where many of us actively partake in regular bad habits like smoking, drinking, consuming unhealthy foods, and look past our largely inactive lifestyles where only about 23% of us actually get the recommended 150 minutes of aerobic and muscle-strengthening exercise per week. While the impact of these not-so-great choices may be out of sight and therefore out of mind for younger people, the reality is that the delayed effects are just a ticking time-bomb of chronic disease waiting to happen.
Part two in a two-part series (access part one) Imagine calling your chronic care case management patient for their weekly check-in only to find out that they haven't taken their blood pressure medication in four days. While the direct effect of the missed medication is worrisome, even more concerning might be the reason why the patient is skipping doses in the first place. Within chronic care management programs, it's not uncommon to run into these types of patient problems, and these situations probably arise more often than we like, or we'd like to admit. Often, the cause or a significant contributing factor to patient non-adherence with a chronic care management program is social determinants of health (SDoH).
Part one in a two-part series It's been well-documented that social determinants impact the health and wellness of patients in numerous ways, but how do we more effectively address those issues that impact patients negatively? One path provider organizations are increasingly taking to help them overcome social determinants of health (SDoH) challenges is through the addition of chronic care management solutions.
The results of a survey suggest that upwards of about 85% of Medicare annual wellness visits (AWV) may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS). The results should motivate providers to verify that the tools they are using during AWVs for Medicare patients effectively prompts them to ensure no required components are missed. If a required element is missed, the AWV can be considered non-compliant by an auditor, potentially leading to clawbacks and other penalties. In egregious and willful cases, a non-compliant practice could even face exclusion from Medicare or criminal liability.
