Preventive care billing starts with the right benefit.
Patients often use “physical,” “wellness visit” and “screening” to mean the same thing. Their health plan may treat them very differently. We help preventive medicine practices clarify the service being scheduled, review the benefit and document what was performed so the claim and the patient’s expectations stay aligned.
- ClaimsDocumentation review
- A/RPayer follow-up
- ReportsClear next actions
Three ways Preventive Medicine claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- A wellness visit is mistaken for a physical
A Medicare annual wellness visit is not a routine physical exam. We help distinguish the booked service from other preventive or problem-focused work before the claim is submitted.
- The screening is outside the plan’s requirements
Coverage can depend on eligibility, prior service dates and clinical circumstances. We review those details and flag uncertainty before treating a service as covered.
- The reason for testing changes
A screening and an investigation of symptoms may have different billing implications. We use the documented reason for the service instead of choosing a label solely to avoid patient cost-sharing.
What we bill for preventive medicine teams
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Preventive Medicine accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- Match appointment names to actual services
We review how your practice schedules wellness, physical and screening visits so the billing team receives a clear starting point.
- Check coverage before making assumptions
Eligibility and relevant service history are reviewed. Questions about benefits or noncovered work are raised with the practice.
- Read the record for the service delivered
Documentation, diagnosis selection and any separate problem-focused work are checked together before submission.
- Review patient-balance questions
We trace unexpected balances back to the benefit, coding or payer decision and explain which next step is supported.
Included for preventive medicine teams
- Charge review against the clinical record
- Eligibility and benefit checks within the agreed scope
- Submission and rejection follow-up
- Payer denial review and supported appeals
- Payment posting and balance reconciliation
- Aged receivable review
- Specific documentation queries for your team
- Reporting on outstanding work and next actions
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Preventive Medicine billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Preventive Medicine service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat preventive medicine teams ask
Will preventive visits always be free for patients?
No. Patient responsibility depends on the plan, eligibility, service and circumstances. A preventive appointment can also include other work that has separate cost-sharing.
Can a problem visit be billed with a preventive service?
Sometimes, when a separately reportable service is supported and the payer’s requirements are met. It should never be added automatically.
Do you bill employer-paid services to insurance?
Not by default. We separate employer or direct-pay arrangements from insurance billing and agree the appropriate workflow for your practice.
Let’s review your preventive medicine billing
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.