Wiki Welcome to Medicare

[pscott]

Hi,
We're having a dilemma in our clinic about what to do when a pt has a welcome
to medicare visit, but Medicare is secondary. Comercial ins companies to do not
recognize the "G" codes. Has anyone figured out how to do this?
Thanks!

 

[bethdeak]

WPS states that for the AWV you submit the codes to the primary then submit the claim to Medicare. It might work the same for the Welcome to Medicare exam.

http://www.wpsmedicare.com/part_b/resources/provider_types/awv-faq.shtml

Question:
The patient's primary insurance does not recognize the G0438 or G0349 procedure codes. How do we submit these charges to Medicare?
Answer:
Submit the AWV codes to the primary insurance and then submit the charges to Medicare for secondary payment.

Question:
How do I bill Medicare for an AWV if the patient has a primary insurance?
Answer:
A provider should always submit the procedure code reflecting the service provided. Bill the primary insurance using the procedure code for the AWV and receive the information (payment or rejection), then bill Medicare. Medicare will process based on the Medicare rules evaluating the payment from the primary insurance. However, if the primary denies because they do not recognize the procedure code, Medicare can make payment.

 

[pscott]

I forgot to say "Thanks". We're going to give it a try.