Stop Chasing After 'Welcome to Medicare' Exam Deductibles

Medical Office Billing & Collections Report 2008: Volume 8, Number 12

"Happy retirement" no longer comes with unwelcome present.

If your physicians perform "Welcome to Medicare" (WTM) exams, also called an Initial Preventive Physical Exam (IPPE), you'll have one less payment battle to wage as of Jan. 1. Here's the scoop from the CPT and RBRVS 2009 Annual Symposium in Chicago.

Starting Jan. 1, the Medicare deductible does not apply to the Welcome to Medicare exam, announced CMS's Amy Bassano in her presentation "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the symposium.

"This program aspect caused a lot of criticism," she said. Now patients who come in for the required enrollment exam will not have the exam applied to meeting their deductible.

What it means: Your patients may be happier. This change really benefits the patients, says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash. "The doctor will be reimbursed the same either way," she adds.

The benefit: You won't need to try to collect from the patient for the Welcome to Medicare exam.

Follow These Solid WTM Exam Tips

Beneficiaries receive coverage for the WTM exam only once in their lifetime -- and only within the first six months after joining Medicare. You need to be careful and make sure the patient hasn't already had his WTM exam, or you'll be left with an unpaid bill despite the change to the deductible rules.

Experts offer these five good practices to help keep track of your new Medicare patients and ensure you get paid for these services:

1. Ask patients to sign an advance beneficiary notice (ABN). Practices often have no way to keep track of whether the patient has already received the WTM exam somewhere else. A signed ABN guarantees that the patient will pay out-of-pocket if Medicare denies the claim.

2. Add a note to patients' files when they've had the exam already. This simple act will prevent you from accidentally performing the WTM exam again for patients who have already had it.

3. Inquire about the patient's exam status multiple times. When the patient makes his appointment, you should ask if he's just enrolled in Medicare, when that enrollment became effective, and if he's had the WTM exam anywhere else.

Then when the patient comes in for his visit, the front-desk staff, as well as the doctor, should ask the same questions.

4. Check patients' eligibility with Medicare to make sure they don't have Medicare Managed Care. Additionally, you should check patients' Medicare cards to confirm their eligibility dates and make sure they're still within the window of when they can get their WTM exam.

5. Ensure that the patient also undergoes a screening EKG. If you don't have this component, the carrier will deny payment for the WTM exam. Bill the service using G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and G0366 (Electrocardiogram, routine ECG with 12 leads; performed as a component of the initial preventive examination with interpretation and report).