AWV Required elements

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Hello,
I have a provider who saw a Medicare patient for a routine physical and billed 99397, claim got denied by medicare.
we are not able to use AWV codes due to the physical did not contain all the AWV required elements.
Should the provider recall the patient back to perform the AWV elements and re submit the claim using AWV codes.

Much appreciate your Response !

Thanks
 
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coding4fun

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Awv

You can still salvage some cash here if your patient has a 2ndary carrier (that is not a supplement). Carriers like FEP,Blue, etc will pay when Medicare denies. Otherwise you have to write off and the pt cannot be resp as it is due to practice not performing services correctly.
 
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You can still salvage some cash here if your patient has a 2ndary carrier (that is not a supplement). Carriers like FEP,Blue, etc will pay when Medicare denies. Otherwise you have to write off and the pt cannot be resp as it is due to practice not performing services correctly.

This is not entirely accurate. A claim would have to be denied to patient responsibility in order to bill a secondary.


Hello,
I have a provider who saw a Medicare patient for a routine physical and billed 99397, claim got denied by medicare.
we are not able to use AWV codes due to the physical did not contain all the AWV required elements.
Should the provider recall the patient back to perform the AWV elements and re submit the claim using AWV codes.

Much appreciate your Response !

Thanks

You can't ask the patient to come back in for additional services as the date of service would change from the original AWV. (This wouldn't be very good practice anyhow)

What was the exact reason for the encounter? If it was strictly intended to be an AWV and the provider didn't meet all of the criteria, then it would have to be a write off for the provider. The visit needs to be medically necessary and from what you've stated, it would never be considered as such.
 
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