Wiki Medicare denial - This is the first time I have come across this issue

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Yathink67

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This is the first time I have come across this issue. A patient was in the end of December and their office visit was denied due to
"Benefit Maximum for time period has been reached"
Did I incorrectly bill for an annual visit with G0439, Am I supposed to bill the patient, am I supposed to write it off?
Any help on this matter would be greatly appreciated, thank you!
 
Thank you Michellede, Was thinking maybe it had something to do with the end of the calendar year, but THAT didn't even cross my mind for some reason!!
 
I agree with Debra with one difference.

By coincidence this came up in our office yesterday. The Medicare Annual Wellness Visit is payable 11 full months after the previous AWV (not every 365 days). In other words, if a patient has an AWV today (Mar 10) then next year, the earliest they would be eligible would be Mar 1.
 
Medicare Denial

Also, if you did not get an ABN, you will need to write this off. I would make sure to education the scheduling staff the requirements of the wellness visits, so this does not become a repeated denial.
 
We find going on the CONNEX web site really helps with this. There have been times when the patient has had their Medicare part B for quite a while and you would assume the G0438 has already been billed and we send out the G0439. This has come back denied, to help avoid this we are checking all new Medicare patients either on CONNEX or calling Medicare directly. It can be time consuming but saves time in having to fix a denial in the end.
 
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