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Monday May 22, 2017

How to avoid the unpaid Medicare annual wellness visit

One of the challenges of getting paid for Medicare annual wellness visits (AWVs) is that Medicare reimburses only one AWV a year per Medicare patient – and your patient may get that visit elsewhere without you knowing it. Even worse, you will not discover that fact until after you have provided the service and received a claim denial from Medicare. What’s a practice to do?

One strategy is to encourage your Medicare patients to receive their AWVs from you. A letter to your patients could emphasize that the AWV is part of the ongoing relationship between the patient and your practice, a relationship that enables you to provide them with continuity of care. It could then explain how Medicare pays for only one wellness visit per year and that you can’t provide it if they receive an AWV somewhere else.

Another strategy is to check a Medicare patients’ billing history to see if Medicare has paid for an AWV within the past 12 months. You can do this a couple of ways. One way is to contact your local Medicare administrative contractor (MAC) to verify whether enough time has passed since the patient’s last AWV for you to get reimbursed. If the patient has moved or spends part of the year in another part of the country (e.g., is a “snowbird”), you may also need to contact the MAC for the part of the country where the patient lived previously. You can identify the relevant MAC and their contact information through an interactive map(www.cms.gov) from the Centers for Medicare & Medicaid Services (CMS).

Alternatively, you may want to access the CMS HIPAA Eligibility Transaction System (HETS) Help (270/271)(www.cms.gov), a secure website that provides Medicare information for patient eligibility and liability. HETS is available to you for free at any time with limited functionality outside of normal business hours.

There are many frequently asked questions about the Medicare AWV. Don’t let “Am I going to get paid for this?” be one of them.


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

Posted at 09:51AM May 22, 2017 by Kent Moore

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