Payer Updates: Get to the Bottom of These Pressing Issues

Subscribe or sign in to view the full article.

Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews recent Medicare payer updates from MACs and related contractor education sources. It is aimed at practices, coders, and billing staff who need a broader understanding of how Medicare billing and documentation guidance may differ by payer and service type. The discussion focuses on common operational issues involving patient acceptance, annual wellness visit participation, incident-to services, and related reporting considerations.

Why This Topic Matters

These payer updates can affect day-to-day billing workflow, documentation practices, and compliance risk for Medicare Part B providers and their staff.

Article Sections

  1. Contract with Medicare? You Can Still Limit New Medicare Patients

    Discusses a payer-related question about whether practices may limit acceptance of new Medicare patients. The section summarizes contractor commentary on provider choice and the implications once a patient is accepted.

  2. Individual Payers Can Decide Who Performs AWVs

    Covers Medicare annual wellness visit guidance as presented by a MAC, including who may participate in the service and how related documentation and reporting topics are addressed.

  3. Be Within ‘Speaking Loudly Distance’ for Incident-to Services

    Reviews Medicare incident-to service guidance from contractor education, including supervision, personnel relationships, and situations that may affect whether the service remains within that framework.

What You Will Learn

  • How MAC guidance can shape Medicare billing and practice operations
  • General considerations for annual wellness visit participation and reporting
  • Broad supervision and staffing concepts related to incident-to services
  • How payer education may address common Medicare compliance questions

Who Should Read This

  • Medical coders
  • Billing staff
  • Practice managers
  • Compliance staff
  • Physicians and non-physician practitioners

Codes Discussed

  • HCPCS Level II: G0438
  • HCPCS Level II: G0439

Modifiers Discussed

  • CPT: 25

Subscribe or sign in to view the full article.

Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

Thank you for choosing Find-A-Code, please Sign In to remove ads.

Aimee- AI -powered coding assistant - Try it now for Free Would you like Aimee - AI
to help you with this?