Welcome to Medicare

I get asked frequently the requirements to bill a routine physical to Medicare.

Here is the rule: Medicare does not pay for routine physicals. You would not send a claim and you would not have the patient sign an ABN form. Just let the patient know that it is not covered and they need to pay for the services at the time of the visit. If you need a denial to send to a secondary, then you would submit the claim with the modifier GY to indicate that you are sending the claim only to receive the denial.

Now for rule there is an exception. Medicare will cover a "Welcome to Medicare" physical. It is one time only and MUST be within the first six months of becoming eligible for Part B. There are seven components that need to be meet. The reimbursement does not include any clinical labs.

1. A review of the patients medical and social history with attention to modifiable risk factors
2. A review of the patients potential risk for depression
3. A review of the patients functional ability and safety level
4. An exam that includes their height, weight, blood pressure, and visual acuity
5. Performance and interpretation of an EKG
6. Education and or counseling based on the results of the previous five components
7. education, counseling and referral with brief written plan for obtaining the appropriate screenings and/or other Part B preventive services.

The provider (physician, qualified NPP, or hospital) may also provide and bill separately for the screenings. The patient will have a %20 coinsurance and may have to meet a portion if not all of the deductible.

Don't forget to check the LCD and NCD for your specific Medicare carrier.

Welcome

Welcome to PM Billing and Consulting. We are a physician billing and revenue cycle management firm located in Utah. We are members of both the Professional Association of Health Care Office Management (PAHCOM) and the Utah Medical Group Management Association (UMGMA). We are certified professional coders (CPC) through the American Academy of Professional Coders (AAPC) and Certified Endocrine Coders (CEC) through the American Association of Clinical Endocrinologists (AACE).

We currently bill for endocrinology, pediatrics, opthalmology, and family practice.

If you are looking for a full service billing company or just need some advice in a few areas such as charge slip creation or setting fees, we can help.

Check out our full list of services at our website: www.pmmedicalbilling.com

You can email or call us with questions. info@pmmedicalbilling.com or 801.649.6325

We look forward to working with you!