Wiki well women exams for medicare patients

jebond123

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Hi
I need some advice on the following scenario: My boss is OB/Gyn and has a contract with Medicare. He is asking if we can decline providing wellness services to our Medicare patients based on reimbursement. We are a small
practice and the routine care reimbursement is not covering his time and staff oversight. He has even contemplated terminating his participation with Medicare but I was warned by Medicare Provider Contracting that this was a bad idea due to the fact that we could incur huge penalty fees if we were to provide care for a Medicare patient and not go by their guidelines. I really don't understand any of this and any help is greatly appreciated.
Our reimbursement for G0101 only is just around $50 and does not begin to cover the time and care given. Paps are only every 3 years so we are stuck with a $50 reimbursement in most cases.
Thank you for any help.
Janet
 
If you are providing more than a cervical/breast cancer screening captured by G0101, you should be coding for whatever other services are being provided.
If the clinician is addressing/treating any problems during the visit, a problem oriented E&M 99202-99215 may also be appropriate.
Many OBGYNs are providing a comprehensive preventive well woman exam, which is best described by 9938x-9939x. These services are not a Medicare benefit and may be billed to the patient (unless there is a secondary that covers it). As this is a statutorily excluded Medicare service, you are not required to have an ABN on file, but I think it's important from a customer service standpoint.
@nielynco has a very comprehensive guide about this and I'll have to find the link.
 
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