Part B Insider (Multispecialty) Coding Alert
CMS Reveals Auditors' Findings Regarding AWVs
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Plus: Need guidance on signature requirements? CMS has your document.
Although annual wellness visits (AWVs) have been around for a while, you may still find them a bit of a mystery. And that seems to be the case for quite a few practices, if the Recovery Audit Contractor (RAC) findings are any indication.
CMS published the most common error seen among AWV claims (G0438-G0439) in its January Medicare Quarterly Provider Compliance Newsletter.
The biggest culprit? Repeated billing of G0438 (Annual wellness visit…initial visit). You can only collect for the initial visit once per beneficiary’s lifetime. That means that if the patient has had an AWV already—even if it was several years ago—you should report G0439 (Annual wellness visit…subsequent visit) for the successive annual wellness visits.
However, auditors don’t appear to only be seeking more money from practices. The Newsletter also outlined several instances where Medicare auditors discovered that MACs underpaid practices. For instance, auditors found that one provider reported 99215 for a new patient consultation. After reviewing the records, the auditor discovered that the physician deserved more reimbursement because he should have reported 99205, since it was a new patient and not an established one. The MAC then reimbursed the practice for the difference.
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