Physicians work hard to generate revenue, and with slim operating margins, they don’t want to contend with costly recoupments. Compliant coding and billing helps them avoid the focus of a pre- or post-payment audit.
This article discusses four services that physicians say pose payment challenges along with general tips for coding compliance.
Annual wellness visits vs. physicals: Know Medicare requirements
It’s easy to confuse the AWV and Initial Preventive Physical Exam (IPPE) because both are Medicare-covered services for preventive health. However, there are some notable differences, says Sonal Patel, CPMA, CPC, a coding and compliance consultant with Nexsen Pruet LLC, a business law firm in Charleston, S.C. Patel provides these tips for compliant billing:
1. Know what’s included in the AWV visit vs. the IPPE. Visit the CMS website to learn more about specific requirements for the AWV (including subsequent AWV visits) and IPPE. Documentation should reflect each of these services, says Patel.
2. Report the IPPE, otherwise known as the ‘Welcome to Medicare exam,’ only
once within 12 months of Part B enrollment. The patient is ineligible for this service after 12 months post-enrollment, says Patel.
3. Once the 12 months post-enrollment have elapsed, physicians can bill an AWV once every 11 months thereafter for the patient’s annual AWV. The physician must perform and document all components of the AWV or IPPE, including any updates since the last visit. However, they can’t bill an AWV and IPPE during the same 12 months, says Patel. If the patient needs to be seen after the IPPE but before they’re eligible for the AWV, the physician must bill another appropriate service for which the patient may owe a co-pay or deductible. With the AWV and IPPE, the beneficiary owes nothing.