CMS Preventive Services Medicare Patients

Description

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.

Speaker

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a health care consultant Jan has more than 45 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992. As a member of the American Academy of Professional Coders (AAPC) Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributed to the development of the original AAPC’s independent study, university education programs, and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions, she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/GYN, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37-provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.

Learning Objectives

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

Areas Covered

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

Who Should Attend

Providers
Coders
Office managers
Denial managers

All Days