decisionhealth Newsletters, Part B News - 2017 Issue 9 (September)
Heed the ‘initial’ description of G0438 to get annual wellness visits cleared
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Article Overview
This article reviews Medicare annual wellness visit reporting and the practical billing issues that can affect claim acceptance. It is aimed at coders, billers, and practices that submit preventive service claims, and it discusses eligibility verification, timing relative to prior Medicare preventive services, and distinctions between annual wellness visits and routine preventive exams.
Why This Topic Matters
Understanding the coverage timing and prior-service rules for annual wellness visits can help practices reduce avoidable denials and correctly distinguish related preventive services.
Article Sections
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Coding
Introduces the annual wellness visit topic and frames the billing and denial issues discussed in the article.
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Cut denials down to size
Covers general denial risk factors tied to prior service history and eligibility verification for Medicare preventive visits.
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Bill outside of the Welcome to Medicare period
Addresses Medicare timing considerations involving the initial preventive visit and the annual wellness visit.
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Navigate the difference between AWVs and physical exams
Discusses the distinction between annual wellness visits and routine preventive exams in the context of billing review.
What You Will Learn
- How Medicare annual wellness visit claims are discussed in relation to denial risk
- What types of prior-service and eligibility checks are emphasized
- Why timing relative to Medicare preventive visit milestones matters
- How the article distinguishes annual wellness visits from routine preventive exams
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Primary care practices
- Medicare billing staff
Codes Discussed
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