decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 1 (January)
When patient declines AWV
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Article Overview
This article addresses a Medicare billing and documentation scenario involving a patient who declines an Annual Wellness Visit and asks for a preventive exam instead. It explains the importance of documenting the patient’s choice, notes the roles of CMS and carrier guidance, and discusses the general compliance concerns that arise when covered and noncovered preventive services are offered in the same setting.
Why This Topic Matters
This matters to practices that provide Medicare preventive services because patient preferences, claim submission, and documentation can affect denial handling and payment responsibility. It is relevant for staff who need to understand how to record a declined service and avoid compliance problems tied to service selection.
Article Sections
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Question
The article opens with a billing scenario involving a patient declining one preventive service and requesting another. It frames the payer response and the documentation concern that followed.
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Answer
This section summarizes CMS guidance on documenting the patient’s decision and the general expectation that the record reflect who made the choice. It also includes comments from Medicare contractors about compliance concerns when preventive services are substituted.
What You Will Learn
- How the article frames a Medicare preventive-service billing scenario
- Why documentation of a patient’s decision is emphasized
- What general concerns CMS and carriers have about patient choice and service selection
- Who is involved in the discussion of AWV billing and documentation
Who Should Read This
- Medical coders
- Billing staff
- Compliance personnel
- Primary care practices
- Medicare providers
Codes Discussed
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