Welcome to Medicare: A comprehensive look at what you need to bill and what you need to document for Medicare's new preventive visit

Why This Topic Matters

Accurate billing and documentation for this preventive visit affect payment, compliance, and downstream referrals for Medicare patients. The article helps practices understand the general structure of the benefit and the related administrative requirements.

Article Sections

1. Overview of the new preventive visit

   Introduces the Medicare preventive visit, the eligible patient population, and the time window for furnishing the service. It also identifies the types of clinicians who may provide it.

2. Codes to bill

   Summarizes the billing-related codes associated with the preventive visit and related EKG components. The section focuses on coding structure and payment context.

3. 7 'elements' of the exam

   Outlines the major components Medicare expects during the visit, including history, screening, functional assessment, examination, and counseling/referral activities.

4. The EKG

   Discusses coordination of the EKG component with the preventive visit and related billing considerations.

5. Separate medically necessary E/M

   Addresses the possibility of reporting a separate evaluation and management service on the same date when it is independently supported.

6. Miscellaneous

   Covers additional administrative topics such as bundled services, documentation expectations, and patient cost-sharing.

7. ABN policy for Welcome to Medicare exam

   Explains when advance notice considerations may apply for the preventive visit under Medicare policy.

8. Services to which patients are referred

   Lists categories of preventive and screening services that may be recommended or referred after the visit.