Education

Preventive health visits can be scheduled every calendar year for all Buckeye Health Plan members.

• Allows members and providers to schedule preventive health visits when it is more convenient
• Removes barrier of waiting 365 days from last preventive health visit to schedule a new preventive health visit (for ages 2 and up)

Best Practices

• Consider every visit an opportunity for a preventive visit and an immunization.
• Review patient charts prior to appointments and allow extra time to complete a preventive visit with a sick visit/sport physical or a sick visit with a preventive visit.
• Schedule the next preventive health visit during check out.
• Collaborate with your EHR vendor to incorporate pop-up alerts for preventive services.
• Send reminder notifications via letter, call, text, or mobile app to your attributed/assigned patients to notify them of the need to schedule an appointment and/or a reminder to attend their scheduled appointment.
  • Do not forget about the patients that have not yet been seen. These patients either chose your office or were assigned to it.
  • Medicaid patients generally need 48 hours to arrange for transportation. So, send reminders 48 to 72 hours prior to appointment.

Points To Keep in Mind

• If it is the first time a patient will be seen in your office, only one of the two billed visits can be billed as a new patient visit.
  • Ex: A new patient is seen for a preventive health visit. During the preventive health visit, a patient is identified as being sick; so, both a preventive health check and a sick visit are appropriately completed. The preventive health visit is billed as a new patient visit and the sick visit completed with the scheduled preventive health visit is billed with the appropriate E&M as an established patient.
• If the provider’s documentation supports services for a preventive health visit and a sick visit (with no overlapping documentation components), then separate reimbursement is both warranted and supported.
• When billing a sick visit on the same day as a preventive health visit, bill the appropriate E&M code (ie 99201-99215) with modifier-25 and preventive code (ie 99381-99397).
• Preventive health visits for infants and school age children must be in person.

For additional information see our HEDIS Tip Booklet.

When a patient is seen in the office for a preventive visit, as a new or established patient, providers can bill that diagnostic exam as an E&M-25. Providers should reference the most up-to-date sources of professional coding guidance for valid CPT/HCPCS codes.

To receive payment, follow the billing guidelines below taken from the HEDIS Tip Booklet