Practice Management Alert

If you've decided your practice doesn't have the resources to offer annual wellness visits (AWVs), you aren't legally required to perform them. That's the word from WPS Medicare, a Part B payer in four Midwestern states, which presented a March AWV conference.

WPS Medicare started off the call by reminding providers that the initial AWV (G0438) is a one-time benefit per patient and the subsequent AWV (G0439) can only be reported once a year, so Medicare will deny the claim if you report the code outside of the allowable timeline, and the patient would be responsible for payment.

"You want to be having conversations with your patient concerning whether these services have been provided by someone else," said WPS's Ellen Berra during the call. "This provides a protection for your patient in that they won't have to pay for the bill, but also protection for your office in that you won't have to go after the patient for payment of these charges," she said.

Plus: Your practice can decide not to offer AWV services. "If the physician chooses not to supply AWVs, there is no legal requirement," said WPS's Tom Ryan during the call.

However, if you offer a preventive exam to a patient who has agreed to pay out-of- pocket for that preventive service, you can "carve out" the AWV portion of your preventive exam and bill that to your MAC. "There's no legal requirement that you have to give this particular service," Berra said. "What you could do, though, is what's called 'carve-out.' You'd start with the price of your preventive service and then carve out of that anything that would go along with the annual wellness visit. You would bill the AWV to Medicare, and then the additional amount for the preventive service (the things that are not part of the AWV) you would charge the patient for."