CMS Preventive Services Medicare Patients

CMS (Medicare) covers many preventive services but not all. We will discuss both the covered and non-covered services for Medicare and compare these services to commercial payer guidelines. We will explore the documentation required to bill specific payable services and the timing of specific services for Medicare payment. Knowing when to bill separately for additional services during a preventive encounter is important to your bottom line and the patient’s pocketbook. Are you capturing all the preventive services available for your patients including CMS’s Initial Preventive Physical Exam and AWW visits? Is your front desk scheduling appointments appropriately for preventive versus problem-oriented encounters? Can you bill both services at the same encounter? How do private payers handle preventive and problem-oriented services at the same encounter? Will add a modifier -25 guarantee payment for a preventive and problem-oriented service on the same day? What about immunizations, does Medicare cover all preventive immunizations, and if not which ones can be paid with appropriate coding? Do Medicare and private payers cover well women's services? If so, what specific documentation is necessary?  We will also explore preventive screening tests that may or may not be covered by Medicare. 

• Make the most of payable preventive services to improve your office’s bottom line and to provide quality care to your patients
• Understand the difference between a problem-oriented and preventive service
• Know the difference between private payer and CMS preventive guidelines
• Understand S codes recognized for preventive services for some payers
• Diagnostic preventive services payable by Medicare
• Appropriate use of modifier -25 in conjunction with preventive and problem-oriented services on the same day.
• Bill appropriately for well-women services.
• Documentation requirements for billing G0101 and Q0091
• Understand billing for screening well-woman services versus follow-up on gyn conditions
• Understand the CMS requirement to “carve out” charges for preventive services when performed with other payable services.
• Appropriate diagnosis coding for preventive care and linking of diagnoses for all services rendered
• Know the difference between preventive care and preoperative care

• Codes 99385, 99386, 99387, 99395, 99396, 99397
• Well woman services G0101, Q0091
• S codes
• IPPE and AWW brief discussion
• Diagnostic ancillary screening services covered by Medicare
• CMS payable and non-payable Immunization services
• Carve out as required by Medicare
• Appropriate diagnosis codes to support billing preventive services
• Private payer deviations for preventive services

• Providers
• Coders
• Office managers
• Denial managers