Recovery auditors focus on Annual Wellness Visits

Do you provide Annual Wellness Visits (AWV) to your Medicare patients? Are you aware of the different codes to report the visit, depending on whether the patient has had one before? Medicare’s recovery audit contractors (RACs) are apparently finding that some physicians aren't, and that's leading to Medicare overpayments.

The Centers for Medicare and Medicaid Services (CMS) highlights this issue in the January 2014 edition of its Medicare Quarterly Provider Compliance Newsletter. In the newsletter, CMS notes that Medicare pays for an "initial" AWV for each beneficiary once in their lifetime. All successive AWVs must be billed as "subsequent" AWVs. The corresponding billing codes are:

• G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit
• G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit

Unfortunately, the RACs have reported finding multiple instances of physicians billing G0438 more than once for the same beneficiary.

For more information on Medicare’s rules related to the AWV, check out section 30.6.1.1 in Chapter 12 of the Medicare Claims Processing Manual as well as Medicare’s quick reference guide and booklet on the AWV. You can also find information on the AAFP’s web site through Family Practice Management's article collection on this topic.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted on Jan 16, 2014 by David Twiddy