How to prevent Medicare from denying Annual Wellness Visits

A “Welcome to Medicare” preventive visit is covered by Medicare Part B (Medical Insurance) once during the first twelve months that you have Part B.

Your Original Medicare expenses

If your doctor or another competent healthcare professional accepts the assignment, you won’t be charged for the appointment. There is no need for the Part B deductible.

When additional tests or services are provided by your doctor or another healthcare provider during the same appointment, you might be required to pay coinsurance and the Part B deductible.

These extra examinations or treatments are not covered by Medicare’s preventative coverage.

Annual wellness visit 

Although a routine physical examination is not covered by Medicare, an Annual Wellness Visit (AWV) includes components comparable to a checkup or physical.

Who is qualified?

Any Medicare recipient who has been receiving Part B benefits for at least a year and who hasn’t had an AWV or an initial preventive physical (the “Welcome to Medicare” exam) in the previous year.

The Annual Wellness Visit includes the detection of cognitive impairment. Why does that matter? 

During the examination, the doctor will evaluate a patient’s cognitive performance through direct observation while taking into account information gleaned from the patient report and any concerns expressed by family, friends, caregivers, or others. What else comes with the yearly wellness visit? Your doctor or other healthcare providers may ask you to answer a few health-related questions before or during your session.The term for this is a health risk assessment (HRA). 

The answers could offer crucial details to share with your doctor during the annual wellness visit. The heart, lungs, and other bodily systems may be examined by the doctor (or other health care provider). In addition to taking standard measurements like your height, weight, and blood pressure, the doctor will likely interview you about your daily activities, medical history, and memory. On the back of this sheet, you’ll find a detailed list of everything included.

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How often will an annual wellness visit be covered by Medicare? 

Every year, Medicare will cover an annual wellness visit.

Are there any co-pays or deductibles associated with the visit?

 No. The AWV is exempt from the Medicare Part B deductible and coinsurance payments.

Following are some common justifications for denial:

1. Billing a G0438 (first Medicare AWV) or G0439 (secondary Medicare AWV) if the patient hasn’t had Medicare Part B coverage for at least a year. This circumstance necessitates billing G0402 (IPPE).

2. Charging a patient for a Medicare AWV when they just have Part A of the program. They too must be covered under Part B.

3. Utilizing an incorrect primary diagnostic code. Because AWVs are “well visits,” Medicare will almost certainly reject a claim for one of the primary diagnosis codes that is problem-oriented (such as diabetes or hypertension). Instead, list a good code as the primary diagnosis, such as Z00.0X for an “encounter for the general adult exam”.

According to CMS, Medicare Part B also covers a few other preventative procedures. Bone mass measurements, colorectal cancer screenings, depression screenings, diabetes screenings, glaucoma screenings, medical nutrition therapy, prostate cancer screenings, and breast cancer screenings are a few examples.

Electrocardiograms and lab tests are not included in an AWV, however, a healthcare provider may do these and other tests during the same visit. An individual may be required to pay any appropriate fees, copayments, or deductibles if the doctor bills Medicare for additional services.

Your insurance does not cover the following during your yearly wellness visit:

Visits for illness You will be required to pay a copay and/or deductible if your doctor advises care or a treatment plan after discussing a sickness or symptom with you, such as an infection or abdominal pain.

• Chronic conditions. Any discussion, treatment, or prescription of medications for chronic illnesses or disorders, such as high blood pressure, high cholesterol, or diabetes, is not covered by your insurer for your yearly wellness appointment. 

You will also be required to pay a copay and/or deductible in this situation. Contact us to know more.