Coding Medicare Preventive Services

This document provides coding guidance and instruction related to the various Medicare preventive measures and chronic condition services.

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Ambulatory Quality Measures

The UW Medicine health system is accountable for a variety of ambulatory quality measures across a complex payer mix; Commercial, Medicare, Medicare Advantage, Medicaid, and the Accountable Care Network. Knowledge of not only the metrics to which we are measured, but also the targeted performance thresholds is integral to UW Medicine’s performance goals, as well as the provision of the highest quality of care for all our patient populations.

Ambulatory Quality Measures Grid 2018  – Open & View

Common HEDIS Measures

Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used to measure performance on important dimensions of health care and service across more than 90% of the U.S.’ health care providers. HEDIS progress and performance results are used to identify where our health system needs to focus its improvement areas in order to provide our patients with the best and most appropriate care. Our UW Medicine health system’s performance on HEDIS measures largely contributes to our funding ability to gain the resources to provide the highest quality of care for all our patient populations.

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Medicare Wellness Visit Frequently Asked Questions

The nuances of furnishing the Medicare Annual Wellness Visit can be sometimes challenging to navigate. These Frequently Asked Questions with Answers provide guidance on provision and documentation of the Initial Preventive Physical Exam (aka: Welcome to Medicare Visit), First and Subsequent Annual Wellness Visits.

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Medicare Advantage Payer Grid

This grid details the similarities and differences in between the Medicare Advantage payers around visit types, scheduling and bundling of visits, cost-share for patients and coding information. The Medicare Advantage Payers include: United HealthCare, Regence, Premera, Amerigroup, Humana (NWH only) and Molina.

Updated: October 2018

Medicare Advantage Payer Grid – Simplified    Open & View

Updated: June 2018

Medicare Advantage Payer Grid – Detailed    Open & View