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Re: [MedicalBillers] Medicare denials

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  • Erin Bonine
    Someone i am sure has answered this, but medcare does not cover physicals, other than the welcome to medicare physical in the first year. For those you need
    Message 1 of 10 , Aug 29 5:59 PM
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      Someone i am sure has answered this, but medcare does not cover physicals,
      other than the welcome to medicare physical in the first year. For those
      you need to use specialized codes. If a physical was done, I usually will
      look throught he history and see that really there were several issues
      addressed. For instance our doctor will always address htn, diabetes,
      safety, depression scoring, etc. We are able to go through an code those
      items witht he appropriate e/m level. Does that make sense?

      Erin...who also does not count medicare as my friend!

      On Mon, Aug 29, 2011 at 8:10 AM, Halbert <halberts1@...> wrote:

      > **
      >
      >
      > Ok so Medicare and I aren't friends apparently. I'm getting alot of them
      > back with Non-Covered Charges. I billed for Preventative 99387 with V70.0.
      > Where am I going wrong???
      >
      > Thanks
      > Christy
      >
      > [Non-text portions of this message have been removed]
      >
      >
      >


      [Non-text portions of this message have been removed]
    • Melinda
      In addition to what was already said... Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below) Annual Wellness Visit
      Message 2 of 10 , Aug 30 11:10 AM
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        In addition to what was already said...

        Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below)

        Annual Wellness Visit (AWV) - This is a new benefit beginning for dates of service on and after 01/01/11

        G0438 – First visit
        G0439 – Subsequent visit

        No specific diagnosis code
        Contact the local Medicare Contractor for guidance

        Who is covered: All Medicare beneficiaries who are no longer within 12 months after the effective date of their first Medicare Part B coverage period and who have not received an IPPE or AWV within the past 12 months

        Frequency: Once in a lifetime for G0438, Annually for G0439

        Beneficiary pays:
        Prior to 01/01/11: N/A
        On or after 01/01/11: Copayment/coinsurance waived, Deductible waived

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

        Melinda Brown, CMBS
        Ins Biller

        --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@...> wrote:
        >
        > Ok so Medicare and I aren't friends apparently. I'm getting alot of them back with Non-Covered Charges.  I billed for Preventative 99387 with V70.0. Where am I going wrong???
        >
        > Thanks
        > Christy
        >
        >
        > [Non-text portions of this message have been removed]
        >
      • Melinda
        http://www.cms.gov/MLNProducts/downloads/Annual_Wellness_Visit.pdf
        Message 3 of 10 , Aug 30 11:15 AM
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        • josette sylvan
          No routine physical exam for medicare, no v codes for this type of service. just bill for what you do for the elderly, there is no preventative for them as
          Message 4 of 10 , Aug 31 11:00 AM
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            No routine physical exam for medicare, no v codes for this type of service. just bill for what you do for the elderly, there is no preventative for them as they all everything already, cause there is nothing to prevent, lol


            > To: MedicalBillers@yahoogroups.com
            > From: ecbonine@...
            > Date: Mon, 29 Aug 2011 17:59:03 -0700
            > Subject: Re: [MedicalBillers] Medicare denials
            >
            > Someone i am sure has answered this, but medcare does not cover physicals,
            > other than the welcome to medicare physical in the first year. For those
            > you need to use specialized codes. If a physical was done, I usually will
            > look throught he history and see that really there were several issues
            > addressed. For instance our doctor will always address htn, diabetes,
            > safety, depression scoring, etc. We are able to go through an code those
            > items witht he appropriate e/m level. Does that make sense?
            >
            > Erin...who also does not count medicare as my friend!
            >
            > On Mon, Aug 29, 2011 at 8:10 AM, Halbert <halberts1@...> wrote:
            >
            > > **
            > >
            > >
            > > Ok so Medicare and I aren't friends apparently. I'm getting alot of them
            > > back with Non-Covered Charges. I billed for Preventative 99387 with V70.0.
            > > Where am I going wrong???
            > >
            > > Thanks
            > > Christy
            > >
            > > [Non-text portions of this message have been removed]
            > >
            > >
            > >
            >
            >
            > [Non-text portions of this message have been removed]
            >
            >
            >
            > ------------------------------------
            >
            > Yahoo! Groups Links
            >
            >
            >


            [Non-text portions of this message have been removed]
          • Halbert
            Thanks, this was the G codes I was referring to. Our office hasn t started using them yet, I think it s time to implement them!
            Message 5 of 10 , Sep 3, 2011
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              Thanks, this was the G codes I was referring to. Our office hasn't started using them yet, I think it's time to implement them!



              ________________________________
              From: Melinda <melindadocsmith@...>
              To: MedicalBillers@yahoogroups.com
              Sent: Tuesday, August 30, 2011 2:10 PM
              Subject: [MedicalBillers] Re: Medicare denials


               
              In addition to what was already said...

              Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below)

              Annual Wellness Visit (AWV) - This is a new benefit beginning for dates of service on and after 01/01/11

              G0438 – First visit
              G0439 – Subsequent visit

              No specific diagnosis code
              Contact the local Medicare Contractor for guidance

              Who is covered: All Medicare beneficiaries who are no longer within 12 months after the effective date of their first Medicare Part B coverage period and who have not received an IPPE or AWV within the past 12 months

              Frequency: Once in a lifetime for G0438, Annually for G0439

              Beneficiary pays:
              Prior to 01/01/11: N/A
              On or after 01/01/11: Copayment/coinsurance waived, Deductible waived

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

              Melinda Brown, CMBS
              Ins Biller

              --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@...> wrote:
              >
              > Ok so Medicare and I aren't friends apparently. I'm getting alot of them back with Non-Covered Charges.  I billed for Preventative 99387 with V70.0. Where am I going wrong???
              >
              > Thanks
              > Christy
              >
              >
              > [Non-text portions of this message have been removed]
              >




              [Non-text portions of this message have been removed]
            • Halbert
              If the patients have Medicare primary and then a secondary like AARP or BCBS will the secondary still pay for the G codes?? ________________________________
              Message 6 of 10 , Sep 4, 2011
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                If the patients have Medicare primary and then a secondary like AARP or BCBS will the secondary still pay for the G codes??



                ________________________________
                From: Melinda <melindadocsmith@...>
                To: MedicalBillers@yahoogroups.com
                Sent: Tuesday, August 30, 2011 2:10 PM
                Subject: [MedicalBillers] Re: Medicare denials


                 
                In addition to what was already said...

                Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below)

                Annual Wellness Visit (AWV) - This is a new benefit beginning for dates of service on and after 01/01/11

                G0438 – First visit
                G0439 – Subsequent visit

                No specific diagnosis code
                Contact the local Medicare Contractor for guidance

                Who is covered: All Medicare beneficiaries who are no longer within 12 months after the effective date of their first Medicare Part B coverage period and who have not received an IPPE or AWV within the past 12 months

                Frequency: Once in a lifetime for G0438, Annually for G0439

                Beneficiary pays:
                Prior to 01/01/11: N/A
                On or after 01/01/11: Copayment/coinsurance waived, Deductible waived

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

                Melinda Brown, CMBS
                Ins Biller

                --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@...> wrote:
                >
                > Ok so Medicare and I aren't friends apparently. I'm getting alot of them back with Non-Covered Charges.  I billed for Preventative 99387 with V70.0. Where am I going wrong???
                >
                > Thanks
                > Christy
                >
                >
                > [Non-text portions of this message have been removed]
                >




                [Non-text portions of this message have been removed]
              • Melinda
                You re welcome!
                Message 7 of 10 , Sep 6, 2011
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                  You're welcome!


                  --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@...> wrote:
                  >
                  > Thanks, this was the G codes I was referring to. Our office hasn't started using them yet, I think it's time to implement them!
                  >
                  >
                  >
                  > ________________________________
                  > From: Melinda <melindadocsmith@...>
                  > To: MedicalBillers@yahoogroups.com
                  > Sent: Tuesday, August 30, 2011 2:10 PM
                  > Subject: [MedicalBillers] Re: Medicare denials
                  >
                  >
                  >  
                  > In addition to what was already said...
                  >
                  > Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below)
                  >
                  > Annual Wellness Visit (AWV) - This is a new benefit beginning for dates of service on and after 01/01/11
                  >
                  > G0438 â€" First visit
                  > G0439 â€" Subsequent visit
                  >
                  > No specific diagnosis code
                  > Contact the local Medicare Contractor for guidance
                  >
                  > Who is covered: All Medicare beneficiaries who are no longer within 12 months after the effective date of their first Medicare Part B coverage period and who have not received an IPPE or AWV within the past 12 months
                  >
                  > Frequency: Once in a lifetime for G0438, Annually for G0439
                  >
                  > Beneficiary pays:
                  > Prior to 01/01/11: N/A
                  > On or after 01/01/11: Copayment/coinsurance waived, Deductible waived
                  >
                  > http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
                  >
                  > Melinda Brown, CMBS
                  > Ins Biller
                  >
                  > --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@> wrote:
                  > >
                  > > Ok so Medicare and I aren't friends apparently. I'm getting alot of them back with Non-Covered Charges.  I billed for Preventative 99387 with V70.0. Where am I going wrong???
                  > >
                  > > Thanks
                  > > Christy
                  > >
                  > >
                  > > [Non-text portions of this message have been removed]
                  > >
                  >
                  >
                  >
                  >
                  > [Non-text portions of this message have been removed]
                  >
                • Melinda
                  It depends on the patient s supplemental plan. Some do. If Medicare doesn t pay (for example 99397), then the supplement might not pay, as Medicare didn t
                  Message 8 of 10 , Sep 6, 2011
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                    It depends on the patient's supplemental plan. Some do. If Medicare doesn't pay (for example 99397), then the supplement might not pay, as Medicare didn't pay. You'd have to check on the patient's indiv. benefits to discover.

                    Melinda Brown, CMBS
                    Ins Biller

                    --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@...> wrote:
                    >
                    > If the patients have Medicare primary and then a secondary like AARP or BCBS will the secondary still pay for the G codes??
                    >
                    >
                    >
                    > ________________________________
                    > From: Melinda <melindadocsmith@...>
                    > To: MedicalBillers@yahoogroups.com
                    > Sent: Tuesday, August 30, 2011 2:10 PM
                    > Subject: [MedicalBillers] Re: Medicare denials
                    >
                    >
                    >  
                    > In addition to what was already said...
                    >
                    > Medicare does pay for the IPPE (Welcome to Medicare) - G0402 and now pays for the AWV (see below)
                    >
                    > Annual Wellness Visit (AWV) - This is a new benefit beginning for dates of service on and after 01/01/11
                    >
                    > G0438 â€" First visit
                    > G0439 â€" Subsequent visit
                    >
                    > No specific diagnosis code
                    > Contact the local Medicare Contractor for guidance
                    >
                    > Who is covered: All Medicare beneficiaries who are no longer within 12 months after the effective date of their first Medicare Part B coverage period and who have not received an IPPE or AWV within the past 12 months
                    >
                    > Frequency: Once in a lifetime for G0438, Annually for G0439
                    >
                    > Beneficiary pays:
                    > Prior to 01/01/11: N/A
                    > On or after 01/01/11: Copayment/coinsurance waived, Deductible waived
                    >
                    > http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
                    >
                    > Melinda Brown, CMBS
                    > Ins Biller
                    >
                    > --- In MedicalBillers@yahoogroups.com, Halbert <halberts1@> wrote:
                    > >
                    > > Ok so Medicare and I aren't friends apparently. I'm getting alot of them back with Non-Covered Charges.  I billed for Preventative 99387 with V70.0. Where am I going wrong???
                    > >
                    > > Thanks
                    > > Christy
                    > >
                    > >
                    > > [Non-text portions of this message have been removed]
                    > >
                    >
                    >
                    >
                    >
                    > [Non-text portions of this message have been removed]
                    >
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