CMS (Medicare) covers many preventive services but not all. We will discuss in detail the covered IPPE, better known as Welcome to Medicare Evaluation, and the AWV, Annual Wellness Visit. These services have been in effect since 2005 but in many cases are underutilized. Implementing these services in your practice and improve your bottom line and utilize staff more efficiently. We will explore who can bill for these services, the documentation required to bill these specific payable services, differences in the services, and timing for billing the IPPE and AWV. The required documentation elements are very important and cannot be missed or the service may not qualify for billing. In addition, there are some diagnostic services that may be referred to as a result of the IPPE or AWV that may be covered. Knowing when to bill separately for additional services during an IPPE and AWV encounter is important to your bottom line and the patient’s pocketbook. Is your front desk scheduling appointments appropriately for preventive services? Can you bill additional services at the same encounter as the IPPE/AWV? Will adding modifier -25 guarantee payment for an IPPE/AWV visit and a problem-oriented service on the same day? What additional services are not an inherent part of the IPPE and AWV. Do your Medicare patients understand the difference between a non-payable annual physical and the IPPE or AWV. Confusion in your Medicare population can cause customer service headaches.
- Make the most of payable IPPE and AWV to improve your office’s bottom line and to provide quality care to your patients
- Understand the difference between an IPPE, AWV, and annual physical
- Know what additional services can be billed with an IPPE or AWV.
- Review additional payable diagnostic services that may be recommended as a result of an IPPE or AWV encounter
- Educate staff and providers on calculating the frequency of a payable IPPE and AWV.
- Discuss specific documentation requirements for billing G0402, G0438, and G0439.
- Understand the CMS requirement to “carve-out” charges for preventive services when performed with other payable services.
- Appropriate diagnosis coding for IPPE and AWV
- Know changes associated with IPPE’s and AWVs during the pandemic.
- Identify obstacles to billing IPPE and AWV.
Areas Covered in the Session
- Codes G0402, G0438, G0439
- Frequency requirements associated with IPPE and AWV
- Differences between the annual physical and IPPE/AWV
- Most common mistakes when documenting elements of the IPPE and AWV.
- Additional payable diagnostic services that may be an outcome of the IPPE and AWV encounter
- Billing for additional services during the IPPE and AWV encounter
- Carve out as required by Medicare associated with IPPE and AWV encounters
- Appropriate diagnosis codes to support billing IPPE and AWV
- Problem areas with IPPE and AWV services.
- Coding personnel
- Denial management team
- Front Desk/Scheduling staff
- Office Managers
- Insurance payers
- Physical Assistant
- Medical assistants
- Claims adjuster
- Claims processor
- NP, APN, CNS
- Executive and Administration
- Compliance officers
- Charge Capture
- Medical Records Staff
- A/R Staff
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About the Presenter:
Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a health care consultant Jan has more than 35 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination Committee.
In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.
In previous consulting positions she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.
Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37 provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.
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