The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians.
1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements
Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but have key distinctions.
Here’s how to ensure proper billing:
- Be familiar with the specific requirements for each service as outlined by the CMS website.
- Bill the IPPE, or ‘Welcome to Medicare exam,’ only once within 12 months of a patient’s Part B enrollment.
- After the initial 12 months, bill an AWV every 11 months for subsequent annual visits. Both the AWV and IPPE require complete documentation of all performed components.
- Refrain from billing both AWV and IPPE during the same 12-month period. If a patient requires a visit between the IPPE and their AWV eligibility, use another appropriate service code.
2. Telemedicine: Mastering Codes and Modifiers
Telemedicine enhances accessibility and patient satisfaction, but can lead to billing issues.
Here’s how to avoid denials:
- Utilize the current CPT/HCPCS codes approved by CMS for telemedicine services (reference provided in the original article).
- Utilize place of service (POS) code 02 to indicate the service was delivered via telemedicine.
- Apply modifier -95 when applicable to signify synchronous interactive communication.
3. Chronic Care Management (CCM): Avoiding Common Denials
Improper billing of CCM is a frequent occurrence.
Here’s how to prevent denials:
- Ensure clear communication among providers regarding who will bill for CCM services.
- Set up alerts to prevent billing CCM more often than every 30 days.
- Maintain thorough documentation reflecting the personalized management of all the patient’s chronic conditions.
4. Transitional Care Management (TCM): Tracking Patients and Fulfilling Requirements
TCM can be a revenue source, but requires attention to avoid denials:
- Consider billing an office visit instead, as some commercial payers may not cover TCM.
- Implement a system to track patient admissions and discharges to ensure timely contact (within two business days) following discharge.
- Document all contact attempts with patients, including unsuccessful ones.
- For high-complexity TCM billing (code 99496), document extensive medical decision-making involving a complex list of diagnoses and data with high risks.
Allzone Management Services: Expert Medical Billing and Coding Solutions
Allzone Management Services appears to be a medical billing and coding company based in Glendale, California, with delivery centers in India [US medical billing and coding services]. We offer a variety of services, including:
- Medical billing and coding
- Revenue cycle management (RCM)
- Medical coding
Our claim to have a team of experienced professionals and a proven track record of success. We also focus on providing affordable and customizable services.
Here are some key things to know about Allzone:
- Services: Medical billing and coding, revenue cycle management
- Experience: 20+ years
- Locations: Glendale, California, with delivery centers in India
- Clientele: 60+ clients across the East and West Coast of the USA
If you are considering using Allzone’s medical billing and coding services, it is important to do your research and compare Allzone to other Healthcare providers. You may want to ask us about our experience, pricing.