- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Stream RCM works with providers who are delivering preventive-based, wellness-focused services. Our coders are certified through AAPC and AHIMA and participate in continuous training on preventive service CMS updates. We process Annual Wellness Visits, Welcome to Medicare IPPE examinations, well-child visits, and ACA required screenings and we also work daily with family medicine, internal medicine, OB-GYN, and pediatric practices. Our clients experience decreased denial rates starting 60 to 90 days from the start of onboarding, based on our recurring audit data. The account manager looks at your claim mix each month and identifies payor preventive coverage changes proactively. We provide reports on your clean claims rate, days in AR, and denial reasons described in easy-to-understand terms. The family practice account we work with reduced Modifier 25 denials by 41% within one quarter. We keep up with the current regulations like HIPAA, LCDs, USPSTF scoring to ensure compliance of preventive claims.
From the first well-child visit to a patient’s fortieth mammogram, preventive care in medical billing spans a wide range of services, and each one carries its own rules.
Our billing experts distinguish between Medicare Annual Wellness Visits and problem-oriented visits that are billed on the same claim in order to use codes G0438 and G0439 properly based on the visit number.
We ensure that our vaccines are paired with the proper vaccine codes, we track our lot numbers and VFC eligibility, and we confirm our coverage for each payer so that our immunizations are paid correctly the first time.
Our coders use the right frequency windows for billing mammogram, colonoscopy, and Pap smear screenings to avoid miscoding screenings as diagnostic services and denying medical necessity.
We take care of EPSDT and well-child coding for all age categories by integrating immunizations, developmental screenings, and preventive counseling into a single claim, compliant with every state Medicaid program’s requirement.
We use the cardiovascular, diabetes, and depression screening billing codes along with the corresponding ICD-10 codes as per the requirement of the payer to confirm that the reimbursement is not decreased or denied.
Preventive Care Billing solutions only work when every stage of the revenue cycle is aligned, from the first eligibility check to the final posted payment. Here is what that looks like at Stream RCM.
We identify the root cause of every preventive denial from our analysis of frequency errors, missing modifiers, and eligibility mismatches, and we resubmit claims within 72 hours of the denial notification.
We manage aged wellness visit claims beyond 30 days, starting with the highest value ones of AWV, screening, and immunizations because we do not want preventive revenue to quietly become write-offs every month.
We conduct quarterly documentation audits against CMS’ preventive checklist, analyzing prevention plans and risk assessments line by line before a payer can find cause to question a patient’s file.
Our certified coders code CPT, HCPCS, and ICD-10 pair codes created specifically for wellness visits and never resort to general E/M codes which do not address AWV, IPPE, and screening codes.
We handle payer enrollments, re-credentialing, and revalidation timelines proactively, hence ensuring that wellness visit payments are not stalled due to lapses in the provider's paperwork with Medicare or other commercial payers.
We will reconcile every Explanation of Benefits form with your estimated rates for preventive service reimbursement to detect any instances of underpayment, erroneous adjustment, or failure to apply Modifier 33 cost-sharing exemptions.
Hand your preventive care claims to a team that lives in CMS and ACA policy updates every day.
Outsourcing of Preventive Care Billing has become the sensible option for practices struggling with staffing, changes in payer regulations, and coding guidelines overtaking their in-house billing capabilities. The preventive care visits are subject to more strict limitations on the number of allowed visits and documentation requirements compared to any other type of visit, and one missing regulation may lead to denial of reimbursement and unexpected patient billing. Stream RCM is ready to deal with all of the complexity associated with preventive care regulations, keeping up with the CMS updates to Annual Wellness Visits, Affordable Care Act preventive services regulations, and changes in commercial payer regulations.
| Procedure | CPT Code | ICD-10-CM Code | Billing Guidance |
|---|---|---|---|
| Annual Wellness | G0438 | Z00.00 | Our team verifies eligibility before claim submission and makes sure accurate coding practices to support faster payment. |
| Routine Physical | 99396 | Z00.01 | We confirm documentation meets payer preventive medicine requirements and frequency limitations for established patient preventive examinations. |
| Immunization Administration | 90471 | Z23 | Our coders review vaccine administration claims carefully to make sure compliance with payer coverage policies and accurate payment processing. |
| Depression Screening | G0444 | Z13.31 | Our billing specialists handle documentation and medical necessity requirements before submission to reduce claim issues and improve payment accuracy. |
| Colorectal Screening | 82274 | Z12.11 | We bill according to payer preventive screening guidelines and reduce coding errors that may delay reimbursement. |
The United States Preventive Services Task Force updates its A and B grade recommendations and any changes to them automatically impact the coverage of services at no cost-sharing by the insurers. New changes in the recommendations have led to reducing the age when people start being recommended for colorectal cancer screenings to 45 years and lung cancer screenings among chronic smokers. Practices that fail to update their preventive care billing processes following such changes may end up charging their patients for preventive screenings that should be covered at 100%. The Stream RCM team keeps an eye out for updates from the USPSTF and changes billing codes accordingly.
Our team works seamlessly with your existing EMR or EHR system. You don’t lose any documentation in the process; all that is done is for us to take the information necessary for processing bills and claims.
The addition of new codes due to changes in the immunization schedules, which include the updated recommendation regarding the use of RSV vaccine among older adults and changes in the pneumococcal and shingles vaccines, happens annually. There are codes added together with administration codes, ages and risks for eligible persons and payer-unique coverage time. Failing to keep up-to-date with the change may result in an improper coding wherein the reimbursement is paid either only for the vaccine and not the administration or vice-versa. In addition, solutions for preventive care coding must keep pace with the ACIP recommendation as it is issued. Stream RCM keeps their coding database up to date with the recommendation for the season when it is issued.
Preventive care claims fail for reasons and it affects real revenue. We have analyzed thousands of denied preventive claims and identified the root causes that consistently trip up even experienced billing departments.
Thousands of health-care providers partner with us in order to make their billing and payment processes easier. Each step is taken care of by our team of experts which allows medical practitioners to be able to concentrate on patient care.
When each claim is handled properly, you will have a continuous stream of income to your health care practice.
Proactive auditing and professional coding assessment can reduce the number of claim rejections and compliance issues.
By delegating the billing process, you can save time and allow your employees to work exclusively on patient care.
You can guarantee efficient billing and proper billing, providing good patient experience.
It covers Annual Wellness Visits, IPPE exams, well-child checkups, immunizations, and USPSTF-graded screenings, coded separately from acute or chronic-problem visits to keep payment accurate and compliant.
No. An AWV focuses on risk assessment and a personalized prevention plan, while a physical exam includes hands-on examination. Medicare covers AWVs under G0438/G0439, not the commercial 99381–99397 series.
Yes. As experienced preventive care billing companies work, we code Medicare HCPCS wellness codes and commercial CPT preventive series separately, since each payer type follows entirely different eligibility and coverage rules.
We document the problem-oriented service as distinct from routine preventive work and place Modifier 25 only on the E/M code, never the preventive code, matching current CPT and payer guidance exactly.
Yes, when the problem-oriented work is significant and separately documented. Our coders confirm the medical decision-making meets that threshold before billing both services on the same date of service.
Partner with billing experts who understand prevention and keep your reimbursement accurate every time.
