Compliance: Revisit AWV Fundamentals to Avoid a RAC Review

Why This Topic Matters

Incorrect handling of annual wellness visit claims can trigger audit scrutiny, repayment exposure, and unnecessary administrative burden. Understanding the broader compliance framework helps practices reduce claim errors and better document eligibility and visit history.

Article Sections

1. Distinguish between one-time-only and subsequent for annual wellness visits

   Introduces the article’s focus on Medicare wellness visit categories and the compliance concern that prompted review activity. It frames the discussion around eligibility, repeat billing, and audit awareness.

2. What Determines Whether a Patient is New or Established for This Service?

   Discusses how patient status is considered in the context of preventive visit history and practice recordkeeping. It emphasizes tracking prior professional services within the group practice setting.

3. Remember a Different Provider Requires a Different Code

   Covers the relationship between initial and later wellness visits when more than one physician is involved. It also addresses how payment history and provider changes affect reporting considerations.

4. What If You Do Get a Letter from Your RAC on Your AWV Claims?

   Explains general steps to take if an audit letter is received, including reviewing documentation requests and responding promptly. It also describes the importance of supporting records and appeal options.