Preventive Services


Best answers
I work in a small clinic with 3 physicians. We are having issues with billing for medicare wellness visits as well as other preventive exams.

The main issue is that when patients get into the room, they start discussing other issues with the doctor than what is covered by their insurance for preventive services. With BCBS, they don't cover a preventive exam with an E/M code, so we aren't getting reimbursement for the work that is being done. Also, patients aren't aware of what is covered, so they are getting upset when they have to pay in the end because their insurance company will tell them that the provider "coded the visit incorrectly".

I think we need to educate the patients to find out what is covered before hand. The physicians don't want to discuss billing in the exam room (understandable) but I don't know how else they can let the patient know that if they start discussing their current hypertension issues, this will not be covered under the preventive visit.

I just need some pointers on what other practices are doing for this issue, or if they are even having issues with these! thank you!!