The second type of “preventive visit” is the Annual Wellness Visit (AWV). The AWV can be performed once the Medicare patient is no longer in the first 12 months of Medicare Part B enrollment. This service cannot be performed within 12 months of an IPPE or a previous AWV service. There are two separate codes for AWV services. The first is G0438, which is for the first AWV service performed and can only be billed once in a lifetime. The second is G0439 and are subsequent AWV; these services can be billed annually. AWV services are not subject to the deductible or the 20% coinsurance. Medicare will pay the AWV visits at a 100% of the Medicare fee schedule.

Below is an example of how to bill Medicare “preventive services” for a patient with a Medicare Part B effective date of 01/01/2011.

Medicare Part B Effective Date: 01/01/2011

IPPE (G0402): 01/02/2011

AWV (G0438): 01/02/2012

AWV (G0439): 01/02/2013

AWV (G0439): 01/02/2014

FYI- You may also bill for the IPPE and AWV on the same day as a E&M visit with a 25 modifier.

More information about the AWV-https://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf

IPPE- https://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

Now that the flu season is here, don’t forget to note the recent changes in billing Medicare for the flu vaccine.

To report the flu vaccine for Medicare patient use the following codes.

Medicare Vaccine Codes

Q2035 (Afluria)
Q2036 (Flulaval)
Q2037 (Fluvirin)
Q2038 (Fluzone)
Q2039 (Not Otherwise Specified)

Vaccine Codes

90655 ( Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use)
90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use)
90657 (Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use)
90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use)

When billing for the flu vaccine there are two parts. The first part to bill is the fee to inject the vaccine. The second is the fee for the actual vaccine. It should look as follows
Medicare
G0008 (Administration Code)
Q2036 (Choose appropriate vaccine code)
V04.81 (Diagnosis)
Private Insurance
90471 (Administration of vaccine)
90658 (Choose appropriate vaccine code)
V04.81 (Diagnosis)

For more information on Medicare flu vaccine billing requirements visit http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf .

This information was provided by Mylikia Ross Franklin, Certified Medical Billing Specialist/ Divine Medical Billing, Inc. To contact Mylikia, visit http://www.divinemedicalbilling.com or call (888) 292-8948.
http://ow.ly/6XNr6

So what can a medical practice do to ensure patients keep their promise to pay?

First, a strong financial policy is vital. Be sure to lay out in writing what is expected financially of each patient, what will happen if they don’t hold up their end of the agreement, and require their signature and acknowledgment. It is also a good idea to state that if collection services are needed that the patient may incur additional cost, be sure to check if this is legal in your state.

Here are a few more suggestions-

1. State that Copays are due at the time of service.
2. For patient balances, state the number of statements the patient will received and the time given to pay. (15 days, 30 days, etc.)
3. Adopt a policy to collect a deposit for patients that have not met their deductibles. (I suggest $50)
4. Have clear rules about seeing patients with outstanding balances. (Some suggestions are, requiring a payment of at least half the balance, or that patient’s keep their balance under a $100 threshold and then set up a payment plan for the remaining balance.)

Stick to your guns. The word can spread fast that a practice has a more than lenient practice for collecting co-pays or payments on accounts. Once patients experience not having to pay, it is extremely hard to get them to start. I can’t remember how many times I have heard, “Well, I have never gotten a bill before!”.  Using Divine Medical Billing as your billing service gives the perfect opportunity for a statement such as, “I’m not involved in the billing process, please contact our billing service”.

Of course there will be times when patients will need to make payments. Offering a solid payment plan option can reduce outstanding patient balances, and be a fair option for the patient. Having the patient place a credit or debit card on file will insure they commit to the payment plan and reduces the burned of sending additional patient statements.

Lastly, collect on balances and deductibles at the time of service. It’s a great idea to practice with your front office staff kind ways to ask for payments.

Here are a few starters.

Collecting  Copays.

“Before I can get you fully checked in, I will need to collect your copay. That will be $20 for today’s visit, we accept cash or credit.”

Collecting on balances.

“I see you have a balance on your account. Would you like to take care of that with cash or credit?”

Reply to patients when they says they aren’t able to pay.

“That’s not a problem. We are happy to work with our patients. If you provide a credit or debit card, I can have our billing agency set you up on an affordable payment plan.”

Hopefully these tips will set and/or keep your practice on a steady upward financial trend.

Until next time,

Mylikia T. Ross, CMBS, BSBM

Certified Medical Billing Specialist

“These are non-covered services because this is a routine exam or screening procedure”

Medicare does not cover physical visits. Even if  a preventive code like 99387 isn’t billed but the ICD-9 or diagnosis code V70.0 is billed with a 99215, the claim will still be denied.

I know how hard providers work to provide good care. However, it is important to have awareness of services that are not reimbursed by Medicare. If the patient has no complaints but still desires to have a “check-up”, be sure to obtain a signed Advanced Beneficiary Notice (ABN)  and make them aware that they will be responsible for the bill.

To see preventive services that are covered by Medicare visit

http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

For a copy of the Advanced Beneficiary Notice (ABN) visit

http://www.cms.hhs.gov/BNI/Downloads/CMSR131G.pdf

Until next time,

Mylikia T. Ross, Certified Medical Billing Specialist

Our team is excited about all the success this year will bring for our clients. We have some new processes that we will roll out this year to ensure your success. Please take time to comment on our blog page and link up with us on facebook and twitter. We plan to be very active this year so look for more to come.

As you know, the beginning of the year is deductible time for most patients and deductibles can really deduct your cash flow. The good news is, there are measures to ensure that deductibles don’t cause a disaster to your bank account.

1. Be sure your front desk administrator is checking benefits each and every time a patient is seen. Verify which patients have deductibles, the deductible amount, and how much if any of the deductible has been met.
2. Consider adopting a policy for patients with deductibles. I suggest requiring patients with unmet deductibles to pay a $50 deposit. This will help towards the balance the patient will owe and offset the decrease in collected revenue. Some practices may choose to collect their self pay rate. This is also a good suggestion as long as the rate is not too high. If the rate is too high, it could lead to an abundance of patient credits and refunds.
3. Check patient balances at check in. Identify patients that have outstanding balances at the time of check in. This will help to increase the practice revenue and offset the decrease due to deductible season. Also, this will help identify patients with deductibles that might have been missed.

We realize that medical billing and coding is always changing. Unfortunately, it usual is not in our favor. As savvy business people, we know the power of being proactive. We can overcome many challenges by simply foreseeing and planning.

We wish you an abundance of success during this deductible season and throughout the entire year!

Until next time,

Mylikia T. Ross, Certified Medical Billing Specialist

Here are some suggestions to help minimize your accounts receivables.

1. Be sure your front desk administrator is checking benefits each and every time a patient is seen. With unemployment and layoffs on the rise, it is very possible for patients to lose insurance benefits from one visit to the next.

1. Accuracy is a must!!! When entering patient demographics and insurance information, it is critical to be precise. Something as simple as an extra digit in the zip code can cause a rejection at the clearing house. Watch for spaces and symbols in the policy ID and group number. For most insurances including the space or symbol will cause rejections at the clearing house. Be sure not to use nick names. Use the name listed on the patient insurance card. Use the note or alert area to remind staff that the patient like to go by a different name.

1. Be sure the services you plan to provide during the visit are covered under the members plan. Example, if a patient is being seen for a preventive visit, be sure the patient has preventive coverage.

1. Beware of Medicare Advantage/Replacement Plans. More and more Medicare eligible are taking advantage of Medicare replacement plans. When checking benefits for Medicare patients, be sure to go the extra step to hear HMO assignment information. This should be checked on each and every visit. For those actively using CollaborateMD eligibility check, don’t forget to stroll to the bottom of the benefit report to the other or addition payor section. If the patient has a replacement plan, it will be listed there.

Together, we can decrease the amount of unpaid claims and contribute to an increase in reimbursements.

Until next time,

Mylikia T. Ross, Certified Medical Billing Specialist

The first obvious that stands out is expertise. Focus is the key to developing the greatest potential. The sun is the greatest source of energy in the world. However, because of its lack of focus it has minimal affect. Now, take a laser. Not nearly as great as the sun, but with focus, it can burn a whole through metal. Having a team dedicated to do nothing but focus on medical billing stands to produce much greater outcomes.