IPPE or AWV? Navigating the Yearly Medicare Visits

In the July 2018 issue of the AAPC’s Healthcare Business Monthly, Zelis Manager of Appeals Amanda Turner outlines the different Medicare visits a patient may request and corresponding coding and reimbursement benefits, below is an excerpt.

At Zelis, our team of clinical professionals reviews and reconciles $140+ billion in claims prior to payment, including Medicare claims, to ensure that our clients are paying the right amount for services rendered.  We use leading-edge, proprietary technology with expert insight from our staff of CPCs, RNs and MDs to analyze every claim, identifying billing and coding accuracy by cross referencing claim history and data. 

Our pre-payment cost management approach has generated more than $21 billion in savings for our clients.  We believe there are many opportunities to extract errors, waste and abuse in U.S. healthcare system.  To learn more about the importance of proper coding and Zelis’ pre-payment approach to payment integrity, click here

In the July 2018 issue of the AAPC’s Healthcare Business Monthly, Zelis Manager of Appeals Amanda Turner outlines the different Medicare visits a patient may request and corresponding coding and reimbursement benefits.  Below is an excerpt; for the full article, click here.

Let’s review the different visits a patient may request to see how coding and reimbursement plays out for each scenario.

Possibility No. 1: The Yearly Physical

Medicare does not reimburse for preventive medicine services (CPT® 99381-99397). For these services, the patient should be asked to sign an Advance Beneficiary Notice (ABN), to acknowledge responsibility for the cost of the service, outside of any secondary insurance coverage.  A patient calling to schedule a visit that is 100 percent covered by Medicare is not requesting a yearly physical.

Possibility No. 2: The Initial Preventive Physical Examination (IPPE)

The IPPE, or “Welcome to Medicare” preventive visit, is a one-time visit provided to Medicare Part B patients within their first 12 months of Medicare enrollment.

Possibility No. 3: The Initial AWV

A patient requesting an annual visit may be eligible for an initial AWV, which is a one-time-only benefit for Medicare Part B beneficiaries who are not within the first 12 months of their coverage effective date.

Possibility No. 4: The Yearly AWV

A Medicare Part B patient may receive a yearly AWV to develop or update their Personalized Prevention Help Plan with their primary care physician. This AWV is offered once every 12 months ― at least 11 full months must have passed since the last AWV or the IPPE.