February 1, 2018
The beginning of the year is an ideal time to reach out to your Medicare Advantage patients and schedule preventive health visits, many of which are free. Read more below about the different types of visits and how to bill them correctly.
Three types of preventive care visits
Preventive care visits are an excellent opportunity for you and your patients to plan care for the year, while documenting and managing chronic and complex conditions.
Welcome to Medicare Visit - for new Medicare patients only
The Welcome to Medicare Visit is sometimes referred to as the Initial Preventive Physical Examination. This is a one-time appointment to be scheduled within the patient's first 12 months of enrollment in Medicare. It's a great way to gather up-to-date information on family medical history, health screenings, shot records, and other preventive care services for your patients.
Annual Wellness Visit
The Annual Wellness Visit (AWV) is a chance for you to develop your patient's personalized prevention plan based on their current health situation and risk factors. Health risk assessments are also part of the AWV. Medicare will cover one AWV once every 12 months for patients who've been enrolled in Medicare for longer than 12 months. Some providers choose to complete the Annual Wellness Visit in lieu of an annual preventive exam.
Annual Preventive Exam
An annual preventive exam, also known as a routine physical exam, is covered annually. These exams are an opportunity for you to learn additional information} about your patient's medical and family history, perform a comprehensive physical exam, and address any abnormalities or signs of disease.
Important reminders about billing preventive visits with other services
Premera doesn't pay for more than one preventive visit type on the same day. Active but stable conditions that require no or little additional work should be submitted on these preventive visit claims subsequent to a preventive diagnosis, if supported by sufficient documentation.
When acute or exacerbated chronic conditions are managed during this visit, you may consider using an office E/M code in addition to the preventive visit CPT/HCPCS code, following coding guidelines. E/M visits, labs, and other procedures may generate additional cost for your patient, so be sure to discuss cost share prior to providing the service. After submitting your claim, fax a copy of the signed chart note for the preventive visit to 800-647-2844 for review. If you'd like to allow Premera access to your EHR, we can pull these records for you.
Contact our provider engagement team for more information on billing preventive care visits and on enabling Premera to pull your records.