Wiki Medicare Annual Wellness Visit

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jhendrix08

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Looking for some guidance/advice on Medicare Annual Wellness billing...

We realized that some of our patients that were seen for their AWV should have been billed as the initial (G0438) and not the subsequent (G0439). We have already received payment from Medicare for the subsequent code. How would you go about correcting this and rebilling for the initial AWV? Is this a "reopening" that I should submit on the Medicare website or should I submit a corrected claim? I'm a fairly new biller so I would greatly appreciate any help on the best way to go about this. Thanks!!
 
As long as your documentation supports the code you billed you shouldn’t need to rebill anything. If it doesn’t you can do an online reopening to void the claim billed in error and then bill the correct code. Hope this helps.
 
Thanks for your reply! I've not done a reopening yet. So, when I reopen the claim I can void the one with the incorrect CPT code and make the change with the correct one within the reopening? So no need to submit a new claim? Also, how does the payment work? Will Medicare want to recoup the amount they paid on the incorrect CPT code or will they just pay the difference with the new code? (the new, correct code, has higher reimbursement) I appreciate your help so much!!!
 
I don’t believe you can change the CPT code online. I would void the one billed in error and wait until you received a refund request before billing the corrected claim. Luckily the website is pretty easy to use and I usually see the refund request letter in less than 2 weeks. They will process the new claim at the normal allowable rate once the first one is voided.
 
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