1. If the patient is over 65, why is UHC primary? Medicare should have taken over at this point.
2. Assuming Medicare should be primary, does this visit not qualify for Medicare's AWV? (See: http://blogs.hcpro.com/medicarefind/...ellness-visit/)
If you bill this out as 99397 to Medicare, they will deny, and UHC won't pay either. There's no reason that UHC should be primary if the beneficiary is over 65. If they aren't 65 yet, then 99397 isn't the right code anyways, so I'd make my determination based on how the patient's prevenive benefits looked - if they cover most services with no deductible, then I'd go by commercial rules. If the majority of the balance is going to end up at Medicare anyways, you'd be better off with the AWV code, if you can bill it. I hope that helps, and wasn't as confusing as it felt when I typed it.
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