• 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 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

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.