ED Coding & Reimbursement Alert - 2020 Issue 2
Recovery Audit Contractors: Expect Heightened Scrutiny on AWV and IPPE Blunders in 2020
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Article Overview
This article explains why Medicare recovery audit contractors are scrutinizing preventive visit claims and highlights the kinds of billing issues that can trigger review. It is relevant to coders, billers, compliance staff, and providers who handle Medicare preventive services and want to understand the general scope of the audit focus, the organizations involved, and the kinds of policy guidance being discussed.
Why This Topic Matters
Preventive visit coding under Medicare is a frequent source of denials and audit activity. Understanding the article helps practices recognize why these claims draw attention and what broad Medicare guidance is being referenced.
Article Sections
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Background
Introduces the Medicare preventive visit topic and explains why these services are receiving renewed audit attention. Summarizes the general types of claim issues being reviewed by recovery audit contractors.
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Know the Code Distinctions to Avoid the Problem
Discusses the broader need to distinguish between different Medicare preventive visit categories and references timing and eligibility guidance from Medicare sources. Also notes the importance of payer policy review and documentation alignment.
What You Will Learn
- How Medicare audit activity is affecting preventive visit claims
- The general distinctions between annual wellness visits and initial preventive physical exams
- Why timing, eligibility, and documentation matter for these services
- Which organizations and guidance sources are mentioned in the context of the audit focus
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians and clinical practice administrators
- Revenue cycle teams
- Medicare providers
Codes Discussed
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