Following on the heels of our recent article, “Billing and Coding for the Medicare Annual Wellness Visits,” we got this comment from a reader: 

“What if another provider bills for this service without my knowledge and we see the patient and bill the service as well.  How do we get paid if this denies?”

Well, the short answer is that the benefit is only payable under the specific circumstances described in the previous article, so the trick is to make sure you check each patient’s eligibility just prior to performing the service. 

To do this, you need a login to the webpage for checking eligibility for Medicare patients receiving services within your region.  Depending on your location, you will either go to the WPS Medicare C-Snap Registration home page, Palmetto GBA, or a corresponding home page for your region, and follow the instructions for obtaining login credentials for yourself as a provider or on behalf of a provider. 

As an example, we will use the WPS (Wisconsin Physicians Service) Medicare eligibility portal, called C-SNAP (CMS Secure Net Access Portal). The C-Snap Login page lists the utilities and services available through the portal, including:

• “Provide vital claim status data in real-time. With the C-SNAP claim status check, you'll receive detailed information about pending and processed claims.
• Provide the ability to submit a new request for a redetermination/reopening or check the status on one previously submitted using C-SNAP.
• Provide patient eligibility verification. Our eligibility verification process allows you to quickly and easily confirm Medicare eligibility for your patients.
• Provide duplicate remittance advices. You'll be able to instantly view and locally print your entire remittance conveniently at your office.
• Enter a Medicare Part B Professional Claim for the states of IL, MI, MN or WI. C-SNAP Claim Entry does not currently accept Medigap, MSP or Purchased Service claims.
• Send inquiries about C-SNAP, request clarifications on claim denials or policies, and view responses using this secure online messaging system. Personal information stays private and confidential.“

Once you have logged into the portal and verified your user e-signature (these are all determined when you go through the process of getting your login credential), click on “Patient Eligibility.”

The next screen prompts you to choose the provider on whose behalf you are inquiring (yourself, if you’re the provider performing services).

Once you have elected the appropriate provider, you will be asked to enter the information about the patient whose eligibility you are checking.  You’ll need to enter their Medicare Number, Name, Date of Birth, and the Date of Service.  You won't be able to enter a future date into the system, so you should do this check as close to the appointment date as possible. Clicking through to the next screen will show you basic information about the Medicare enrollee’s benefits.  Click on “Preventive Services,” near the bottom of the screen to see a list of codes the patient is eligible to receive and as of what date.  If a procedure code is not listed (i.e. G0402, for the “Welcome To Medicare” Physical), it either means that the patient has already had that visit and exhausted the benefit, or that it has been more than a year since their Medicare enrollment date, or, in the case of G0438 and G0439, it could also mean that not enough time has passed since the previous visit in the succession to make the patient eligible for the next visit.  Remember, each visit must be at least 11 months after the previous visit.

Navigating the C-SNAP eligibility portal is relatively easy and convenient; it’s well-organized and uses terms and explanations that are common in the billing and coding community.  With a service like this at your fingertips, it makes sense to check each patient’s eligibility prior to providing Wellness services, and it minimizes the risk that you’ll get a dreaded denial and wind up providing services for free.