Streamlining Your Healthcare Billing: Avoid Payment Headaches with These Tips

This article tackles common billing mistakes for four healthcare services that can cause trouble for physicians. Here's how to ensure accurate billing and minimize payment issues:

1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements

Differentiating between Annual Wellness Visits (AWVs) and Initial Preventive Physical Exams (IPPEs) is key. Both are covered by Medicare for preventive care, but have crucial differences:

• Know the Requirements: Familiarize yourself with the specific criteria for each service as outlined by the CMS website ([link to CMS website in original article]).
• Billing the IPPE: Bill the IPPE, or "Welcome to Medicare exam," only once within 12 months of a patient's Part B enrollment.
• Billing the AWV: After the initial 12 months, bill an AWV every 11 months for subsequent annual visits. Both AWV and IPPE require complete documentation of all performed components.
• Don't Double Bill: Don't bill for both AWV and IPPE during the same 12-month period. If a patient requires a visit in between, use another appropriate service code.

2. Telemedicine: Mastering Codes and Modifiers

Telemedicine offers convenience and patient satisfaction, but billing can be tricky. Here's how to avoid denials:

• Use Approved Codes: Utilize the current CPT/HCPCS codes approved by CMS for telemedicine services (reference provided in the original article).
• Indicate Telemedicine: Use place of service (POS) code 02 to indicate the service was delivered via telemedicine.
• Apply Modifier -95: If applicable, use modifier -95 to signify synchronous interactive communication (real-time interaction).

For more information: https://www.allzonems.com/coding-for-revenue/