tci Medicare Compliance & Reimbursement - 2017 Issue 8

Compliance: Revisit AWV Fundamentals to Avoid a RAC Review

 Distinguish between “one-time-only” and “subsequent” for annual wellness visits. When a patient presents for his annual wellness visit, make sure you’re using the right code. A recent update from one of the RACs suggests that it is on the lookout for initial AWV codes — which are once-in-a-lifetime codes — billed multiple times. Problem: Performant Recovery, the Recovery Audit Contractor (RAC) for jurisdictions one and five, recently updated that it will be focusing on claims that abuse the one-time-only code HCPCS G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit)...

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