Do You Understand How Medicare Wellness Exams Work?

The "IPPE" is a preventive exam that Medicare pays for. Medicare recipients are eligible for it for one year after the date they become eligible for Medicare. (For most people this is when they turn 65.)

The "AWV" is the name for yearly wellness visits that Medicare pays for AFTER the first year that the patient is in medicare. The first of these visits is the "Initial AWV", each subsequent one is the "AWV - subsequent". The "IPPE" must happen within the first year that the patient became eleigible for Medicare, but the AWV's can happen any time after that first year, whether or not the patient came in for their IPPE.

Eligibility for the IPPE (I also call it the "Welcome to Medicare" exam) starts the minute he turns 65, and ends exactly a year later! It's only during this first year that a patient is in Medicare that they can have this exam. After that, they can have the "AWV". Oops! I gave the next one away!

Since Mr. Smith is way past the first year of Medicare eligibility, he can't have an IPPE. He can have an AWE, and since he's never had one before, this one will be called "Initial AWV"

Medicare only pays for a screening pap smear every other year. So if she wants one before then, she will have to pay for that part of the exam herself.

You can submit an additional charge for work done above and beyond what's in the template for the AWV. But, when calculating the charge level, be sure that you don't give yourself credit for history or exam elements that were already included in the AWV exam. Medicare doesn't like double counting!
Option D - "Ask Virginia" - is actually a good answer to this question. Ask if you are not sure!

In the Template name list, the AWV goes under the name "Medicare Yearly Follow-up" Doesn't matter whether it's the "Initial" or "Subsequent" AWV - it's the same template. You will have to click on the appropriate quicktext at the bottom of the template to bring in the correct charge - there's one for "Initial" and one for "Subsequent".

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IT dept / Med Records / SRC

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