ED Coding & Reimbursement Alert - 2011 Issue 12
Annual Wellness Visits: You Aren't Legally Required to Offer AWVs, One MAC Says
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Article Overview
This article reviews a Medicare MAC discussion of annual wellness visits and common practice questions around offering the service, reporting timing, staffing, and billing combinations. It is aimed at practices, coders, and billing staff who need a general understanding of AWV policy issues and related preventive-service workflow considerations.
Why This Topic Matters
It helps readers determine whether the article is relevant to Medicare preventive visit billing and whether it touches on practice policy, RN involvement, and claim reporting concerns.
Article Sections
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MAC guidance on annual wellness visits
Introduces the Medicare contractor discussion and frames the main questions raised by practices about AWV services.
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Are providers legally required to offer AWVs?
Addresses whether a practice must make the service available and discusses general preventive-service billing considerations.
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Can registered nurses perform the AWV?
Covers staffing and supervision questions related to RN participation in the service, including requirements tied to licensure and patient status.
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Can you bill an AWV along with the patient's Pap and pelvic exam using a modifier?
Reviews whether the billing combination requires a modifier and addresses the claim setup at a high level.
What You Will Learn
- How a Medicare MAC characterized practice obligations related to AWVs
- General reporting and timing issues associated with AWV claims
- Staffing questions involving registered nurses and supervision
- High-level billing considerations when AWVs are paired with other preventive services
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Primary care practices
- Compliance staff
Codes Discussed
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