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HCPCS G0438 and G0439: Background, Coding Tips, and Mistakes to Avoid

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HCPCS G0438 and G0439: Background, Coding Tips, and Mistakes to Avoid

HCPCS G0438 and G0439: Background, Coding Tips, and Mistakes to Avoid

You schedule a patient's first Medicare annual wellness visit (AWV). The patient comes into your practice, or perhaps you meet via telehealth. You furnish the AWV, seemingly checking all of the boxes necessary to deliver this critical yearly appointment that helps prevent illness and get your practice 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. 

The Missing Link to Wellness: Preventive Services

Research from leading expert organizations confirm time and time again the importance and effectiveness of preventive screenings and exams. Yet why are practitioners still having difficulty meeting this relatively inexpensive need for their patients? One argument is that payers place too many obstacles in the way, over-incentivizing reactive care and making the provision of preventive services difficult for practitioners to provide. Another argument is that patients may not be aware they are eligible to receive such services, often at no cost to them, and do not ask about what such services are available. A final argument is that, as a society, we are so focused on taking care of our over-abundance of chronically ill people that practitioners simply lack the time to flip the healthcare paradigm to a preventive care model. It's probably reasonable to assume that all the above play some role in the underutilization of preventive services. The Centers for Disease Control and Prevention (CDC) supports this notion, citing a lack in implementation on the behalf of practitioners.  

Remote Monitoring of Peak Expiratory Flow

The U.S. healthcare system has made some big advancements in the acceptance and usage of telemedicine and remote patient monitoring devices. While the benefits of these services are proving to be valuable for all patients, they are even more important for patients with chronic conditions, including those with lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. With the looming threat of COVID-19 exposure, it may no longer be realistic or safe to continue permitting vulnerable patients to visit a practice for respiratory services. However, the exciting news is that peak expiratory flow can now be measured and monitored remotely with the help of a connected smart peak flow monitor.  

Examples of Remote Patient Monitoring: 9 Top Patient Applications

The COVID-19 pandemic has fueled the adoption of telehealth, with millions of Americans taking advantage of virtual care options over the past several months — many for the first time. While rates of telehealth utilization have recently declined as in-person care resumed, EHR company Epic reported that telehealth visits still accounted for 21% of all visits in July compared to a rate of less than 0.01% prior to the health crisis. A significant contributor to this remarkable increase in usage of telehealth by consumers is the embracing of remote patient monitoring (RPM) by practices and patients, as well as payers and the federal government. When we look at some of the more common examples of remote patient monitoring applications, it is easy how RPM has the potential to transform the delivery of care in the United States. 

Billing Codes for Medicare Annual Wellness Visit & Preventive Services

"It's usually covered by your health insurance, it doesn't take much time, and it's a great way to learn about your present and future health." So begins a Harvard Men's Health Watch article on why men need an annual wellness visit (AWV), but the sentiment expressed in the article applies to any Medicare beneficiary. The Medicare AWV is a valuable service for practices to offer their patients. It's valuable from a health and wellness perspective as the AWV can help physicians prevent disease and detect health issues faster. It's also valuable from a financial perspective as the AWV is reimbursed well, with practices receiving around $160 in average reimbursement per patient. This can be increased by performing, when appropriate, the many preventive services that can accompany an AWV. If you want to capture that revenue, you will need to know and understand the billing codes for the Medicare annual wellness visit. 

Prevounce Remote Patient Monitoring Launches Pulmonology Suite

LOS ANGELES, Oct. 1, 2020 -- Prevounce Health, creators of the Prevounce Care Coordination Platform, announces its release of a remote patient monitoring (RPM) module tailored to the needs of pulmonologists, their practices, and their patients.

Benefits of Remote Patient Monitoring: Why Everyone Wins With RPM

Considering the vast challenges associated with confronting a global health crisis, it's no surprise that 2020 is bringing new advancements to the way healthcare is delivered in the United States. One of the more substantial developments concerns remote patient monitoring (RPM). RPM has technically been around since the early 1970s, but it's been thrown into the spotlight during the pandemic and is experiencing rapid adoption. That comes as no surprise considering the significant and wide-spread benefits of remote patient monitoring. 

CMS Rules for Remote Patient Monitoring in 2020: What You Need to Know

Whether your practice is already delivering or is planning to deliver RPM services to Medicare and/or Medicaid patients this year, you must understand the CMS rules for remote patient monitoring services in 2020. Without this knowledge, you run the risk of not getting paid appropriately for remote patient monitoring by CMS (Centers for Medicare & Medicaid Services) and possibly running afoul of requirements that can jeopardize your reimbursement and lead to regulatory headaches. To help ensure you receive appropriate and timely payments for remote patient monitoring from CMS and avoid legal scrutiny for RPM services, here are three key things to know. 

Prevounce Launches Annual Preventive Health Scholarship Program

Prevounce Health, creators of the Prevounce Care Coordination Platform, announces the launch of an annual undergraduate and graduate scholarship program.

16 Remote Patient Monitoring Statistics Every Practice Should Know

Is your practice looking to help your patients stay healthy and reduce their expenses while generating consistent revenue? Then you're going to want to strongly consider providing remote patient monitoring services. Remote patient monitoring, or RPM, is a form of virtual care technology that is receiving tremendous attention and increased adoption during the COVID-19 pandemic, and rightfully so. Remote patient monitoring allows healthcare providers to monitor and electronically capture medical and other health data from patients for assessment, recommendations, and instructions. As a virtual care technology, this collection of health data, which can include blood pressure, vital signs, weight, heart rate, and blood sugar levels, can occur anywhere but the practice. As long as patients are not in a shared space with the healthcare provider delivering the remote patient monitoring services, they can receive these services. This means a patient can be in their home, in an office, on vacation, in a skilled nursing facility, or any other location. Remote patient monitoring is lucrative for practices, being embraced by patients and payers, and likely to play a significant role in the delivery of healthcare going forward — something these RPM, virtual care, and telehealth stats prove all too well. Note: We’ll be regularly adding new statistics to this resource, so bookmark the page and check back regularly!

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