Preventive physical exams after Medicare

cmercado0526

Contributor
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18
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Lebanon, NH
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Good morning!
Am I in the only office that continues to provide, and bill as such, preventive physical exams for Medicare patients? I am not talking about the IPPE or AWV. Those are not preventive physical exams. A patient has an exam, 99396, for 8 years in a row, they turn 65 and go on Medicare and have the same exam they have had for the past 8 years, now coded 99397. Then they are just shocked when it isn't covered! Or they come from another office and have their first physical at my office. It's a preventive physical exam, head to toe, nuts and bolts physical exam. "I have NEVER had to pay for this with my old doctor!" And they call Medicare who always tells the patient I billed it wrong, it should be an AWV. Well, it wasn't an AWV. It was a periodic comprehensive preventive exam. Am I the only one 'doing it wrong' as the patients are telling me? Do physical exams stop when that red, white and blue card arrives in the patient's mail?
Thanks!
 

CodingKing

True Blue
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3,955
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Once you move over to Medicare FFS the closest you get to a full preventive exam is the Welcome to Medicare visit and AWV. The full preventive exam from his commercial insurance if I understand correctly is more in depth than what is coded to 9939X codes. I believe an ABN would have been needed to advise the patient that the full exam is not covered. I believe your office will have to write off the charges.
 

khristinelouise

Networker
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34
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I had the same issue when I took over at my job. The previous coder/biller would bill out preventative exams as the IPPE or AWV so when I came in and took over and billed them correctly people were outraged (including the doctors who thought they were doing IPPE's and AWV's). I had to find ways to tactfully educate both the providers and the patients on what these visits were supposed to be and what was covered. It was/is very difficult.
 

mitchellde

True Blue
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13,538
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Columbia, MO
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If a Medicare patient makes an appt for the IPPE or a wellness visit, then that is what they expect. If the provider performs a more comrehensive service, you still bill it out as the IPPE one wellness visit codes. You cannot after the fact bill it as a preventive code and have it go to patient responsibility. The patient EOB should tell them that they do not owe the provider if no ABN was obtained. If the patient is informed prior to the provider seeing them that to obtain a full and complete physical is different from the Medicare wellness and they will need to sign he ABN if they want the complete preventive, then you would upon patient agreeing have the provider perform the complete physical and bill it as physical with the modifier for waiver on file.
 

cmercado0526

Contributor
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Lebanon, NH
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These patients are not making appointments for AWV or IPPE. They are making appointments for annual preventive physical exams. No ABN is required because this is a non-covered service. I bill it to Medicare and it comes back as patient responsibility, which it should. I just wanted to know if I was the only one with this problem. If you talk to the patients, I'm doing it all wrong. And I know I am not! And on the flipside, when a patient comes in expecting a prev. physical exam, 99397, (covered by the Medicare PFFS policies) and the doctor doesn't document enough or only covers knee pain instead, then those patients are all irate because their insurance covers preventive..............that I can understand! Bottom line is, they don't read the material they are given.
thanks for the input!
Cathy
 

mitchellde

True Blue
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Columbia, MO
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To many patients the term Annual Wellness Visit and Annual Preventive exam, mean exactly the same thing. Perhaps a little pre encounter discussion with the patient is in order to be sure they are all on the same page. I have spoken with many and they are all under the impression that "Medicare said they would receive a free preventive visit every year" . that is most patients understanding.
 

CodingKing

True Blue
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I'm hoping they are shocked before they receive the service and not after. Even when ABN is not required you are still required to advise the patient before they receive the service. I assume preferably when they are scheduling it if you know they are on medicare

Sorry I was mistaken about the ABN, I was thinking for those who exceeding frequency limitation on an AWV.

To many patients the term Annual Wellness Visit and Annual Preventive exam, mean exactly the same thing. Perhaps a little pre encounter discussion with the patient is in order to be sure they are all on the same page. I have spoken with many and they are all under the impression that "Medicare said they would receive a free preventive visit every year" . that is most patients understanding.
Exactly
 

slivingston

Networker
Messages
55
Location
Mechanicville, NY
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Our offices were having the same issues. A solution to make everyone happy was to perform the IPPE or the AWV with an additional E/M visit that would allow the provider to do the hands on physical and manage their chronic conditions. If they have no chronic conditions that is when the provider would bill a regular Annual Physical code 99397.
 
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