Wiki Medicare Annual Wellness and Welcome to Medicare visits

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Borlickd

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When a patient comes in and the intent of the visit is for either a Welcome to Medicare to a Medicare Annual Wellness Visit and the documentation does not support, would a prevent CPT be billed or would it just be a non-billable service. Just would like to know what everyone else is doing as I cannot find anything in our policies.


Any insight would be helpful

Thanks,
Danielle
 
Borlickd said:
When a patient comes in and the intent of the visit is for either a Welcome to Medicare to a Medicare Annual Wellness Visit and the documentation does not support, would a prevent CPT be billed or would it just be a non-billable service. Just would like to know what everyone else is doing as I cannot find anything in our policies.


Any insight would be helpful

Thanks,
Danielle
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I would bill what the documentation does support. Whether it be an e/m visit or a routine yearly physical.
 
My thoughts on this... If the patient presented for the AWV or IPPE , then it is the providers responsibility to delivery this service. If the provider failed to perform all elements required to bill the service then there can be no charge, UNLESS the patient refused to have certain required elements performed. MY rationale is the patient's intent was to have the annual service performed which Medicare pays for with no copay. If your provider makes a decision to not provide that service as required by Medicare then the patient should not be charged and neither should Medicare. If the provider simply failed to document necessary elements then the record should be returned to the provider for completion.
 
I agree with Debra. If it is not the patient's fault that the requested service was not completed, I can't justify charging them or Medicare for another service.
 
Thank You so very much for the replies... I will take this to my supervisor and we shall go from there.. Again thank you :)
 
Thanks for the advice, ladies!
We have encountered the same problem here.... providers would invariably miss an element or two, making the exam unbillable.
We have remedied that situation by creating a template in the EMR that forces them to address all the required elements.
 
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