Medicare Compliance & Reimbursement

Plus: Medicare no longer requires you to perform a screening EKG with the WTM exam -- but it's still an optional component.

If your physicians perform "Welcome to Medicare" (WTM) exams, also called an Initial Preventive Physical Exam (IPPE), you'll have one less payment battle to wage this year.

Effective Jan. 1, the Medicare deductible does not apply to the Welcome to Medicare exam, announced CMS's Amy Bassano in her presentation "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the American Medical Association's December CPT symposium in Chicago.

"This program aspect caused a lot of criticism," she said. Now patients who come in for the required enrollment exam will not have the exam applied to meeting their deductibles.

What it means: Your patients may be happier. This change really benefits the patients, says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash. "The doctor will be reimbursed the same either way,"she adds.

The benefit: You won't need to try to collect from the patient for the Welcome to Medicare exam, keeping paperwork and headaches to a minimum at your practice.

Beneficiaries receive coverage for the WTM exam only once in their lifetime -- and only within the first 12 months after joining Medicare. You need to be careful and make sure the patient hasn't already had his WTM exam, or you'll be left with an unpaid bill despite the change to the deductible rules.

Experts offer these five good practices to help keep track of your new Medicare patients and ensure you get paid for these services:

1. Ask patients to sign an advance beneficiary notice (ABN). Practices often have no way to keep track of whether the patient has already received the WTM exam somewhere else.

A signed ABN guarantees that the patient will pay out-of-pocket if Medicare denies the claim.

2. Add a note to patients' files when they've had the exam already. This simple act will prevent you from accidentally performing the WTM exam again for patients who have already had it.

3. Inquire about the patient's exam status multiple times. When the patient makes his appointment, you should ask if he's just enrolled in Medicare, when that enrollment became effective, and if he's had the Welcome to Medicare exam anywhere else.

When the patient comes in for his visit, the front-desk staff and doctor should ask the same questions.

4. Check patients' eligibility with Medicare to make sure they don't have Medicare Managed Care. Additionally, you should check patients' Medicare cards to confirm their eligibility dates and make sure they're still within the window of when they can get their WTM exam.

5. Report the screening EKG if performed. Effective Jan. 1, Medicare no longer requires that you perform an EKG with your WTM exam. However, you can still report it "as an optional one-time service as a result of a referral arising out of the IPPE," CMS noted in MLN Matters article MM6223.

You should report the screening EKG with a code from the G0403-G0405 series (Electrocardiogram, routine ECG. ... performed as a screening for the initial preventive physical examination).To read more about how to report the WTM exam for services performed in 2009, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6223.pdf