Stop Losing Revenue on
Chronic Care Management.
Medicare reimbursement is complex. We specialize in capturing the "invisible" revenue from CCM (99490), AWVs, and complex comorbidity coding.
Audit My Medicare ClaimsThe Medicare Geriatrics Revenue Gap
Geriatric practices face a unique financial paradox: they treat the sickest, most complex patients in healthcare, yet operate on some of the thinnest margins in medicine. The reason isn't lack of patient volume—it's systematically missed billing opportunities that represent genuine, earned revenue left uncollected.
National data shows that geriatric practices see patient panels where 60-70% are Medicare beneficiaries, and the vast majority of these patients have multiple chronic conditions requiring ongoing coordination between primary care, specialists, home health, and family caregivers. This coordination work is billable under Medicare's Chronic Care Management (CCM) program, yet fewer than 15% of eligible practices successfully capture this revenue stream.
The three primary revenue streams geriatric practices routinely miss are Chronic Care Management (CCM codes 99490, 99439, 99491), Annual Wellness Visits (G0438/G0439), and Transitional Care Management following hospital or skilled nursing discharges (99495/99496). Each represents substantial income for work your practice is already performing but not billing.
Beyond the new APCM opportunity, most geriatric practices fail to systematically bill Annual Wellness Visits for all eligible Medicare patients. The AWV pays $174 and should be performed annually for every Medicare beneficiary. A practice with 800 Medicare patients should be generating $139,200 in AWV revenue annually, yet the national completion rate is only 30%. That's $97,440 in missed revenue per practice, per year, for a service that takes 20-30 minutes and can be delegated to clinical staff for most of the encounter.
The "Volume vs. Value" Trap
Geriatric practices often see high patient volume but operate on razor-thin margins. Why? Because you are treating patients with 4-5 chronic conditions, but only billing for a standard 15-minute office visit.
If you aren't accurately billing for Chronic Care Management (CCM), Transitional Care Management (TCM), and Annual Wellness Visits (AWV), you are effectively working for free on your most complex cases.
Your clinical staff already spends time coordinating referrals, reviewing medication lists with pharmacies, calling patients about lab results, and managing care transitions when patients are discharged from hospitals. All of this work is billable under Medicare's care management programs, but only if you have systems in place to document the time and submit the appropriate codes.
Beyond CCM: The Full Geriatric Billing Opportunity
Code 99490 (20 mins of clinical staff time) is designed to pay you for the work you are already doing: coordinating care, refilling prescriptions, and reviewing labs. But CCM is just the beginning of your Medicare revenue opportunity.
Complete Revenue Recovery Model
We identify every eligible Medicare patient in your panel and implement systematic billing for all three major revenue streams: CCM, AWV, and TCM.
200 patients × $60.49/month × 12 months $145,176
500 Medicare patients × $174 per visit $87,000
200 hospital/SNF discharges × $183 average $36,600
APCM Alternative: Medicare's new Advanced Primary Care Management program (codes G0556, G0557, G0558) offers bundled monthly payments without time-tracking requirements. For practices finding CCM documentation burdensome, G0557 pays $54/month per patient with 2+ chronic conditions—no minute-by-minute logs required. We help you evaluate whether traditional CCM or APCM generates better revenue for your specific patient panel.
Common Geriatric Billing Mistakes We Fix
After analyzing billing patterns across hundreds of geriatric practices, we've identified five systematic errors that cost practices tens of thousands annually. Here's what we fix:
1Undercoding E/M Visits
Geriatric patients with multiple comorbidities routinely justify level 4 or 5 office visits (99214/99215), yet practices default to billing 99213 out of habit or documentation fear. When you're managing a patient with diabetes, hypertension, CHF, and COPD in a single 30-minute visit, addressing medication interactions and reviewing multiple specialist reports, that's high-complexity medical decision making. The difference between 99213 and 99214 is $75 per visit. Over 2,000 annual Medicare visits, that's $150,000 in lost revenue from undercoding alone. We train your providers on proper documentation of medical complexity and ensure your coding reflects the true intensity of geriatric care.
2Missing AWV Revenue
Only 30% of eligible Medicare patients receive their Annual Wellness Visits nationally, which represents catastrophic revenue loss for geriatric practices. The AWV pays $174 and takes 20-30 minutes—most of which can be delegated to medical assistants or nurses who complete the Health Risk Assessment, review medications, and update the screening schedule. The physician involvement is minimal compared to a typical office visit. A practice with 800 Medicare patients should generate $139,200 in AWV revenue annually, yet most capture less than $42,000. We implement systematic AWV outreach protocols, train staff on delegation strategies, and integrate AWV scheduling into your existing workflow so every eligible patient receives their annual visit without disrupting your schedule.
3TCM Coding Gaps
Transitional Care Management codes (99495 for moderate complexity, 99496 for high complexity) pay $168-$240 for managing patients within 30 days of hospital or skilled nursing facility discharge. Geriatric practices should be billing TCM for nearly every Medicare patient discharged from inpatient settings, yet most practices miss 80% of eligible TCM opportunities. The documentation requirements are straightforward: contact the patient within 2 business days of discharge, schedule a face-to-face visit within 7 or 14 days depending on complexity, and provide medication reconciliation and care coordination. Your practice is already doing this work when Mrs. Johnson gets discharged from the hospital—you're just not billing for it. We implement discharge tracking systems and TCM billing protocols that capture this revenue systematically.
4CCM Time Documentation Failures
Medicare audits of Chronic Care Management services have increased 340% since 2023, and the primary audit finding is insufficient documentation of the specific activities performed during non-face-to-face time. Billing CCM requires documenting not just that 20 minutes were spent, but what specifically was done: "Reviewed hospital discharge summary and updated care plan" (6 minutes), "Called pharmacy regarding medication prior authorization" (8 minutes), "Coordinated with cardiology regarding recent echo results" (6 minutes). Vague entries like "care coordination - 20 minutes" will not survive an audit. We provide your staff with compliant documentation templates and train them on the specific language Medicare requires, protecting you from the clawback risk that has cost some practices $30,000-$50,000 in returned CCM payments.
5Medigap Crossover Errors
Most Medicare patients carry supplemental insurance (Medigap policies from AARP, United Healthcare, Mutual of Omaha) that pays the 20% coinsurance Medicare doesn't cover. Practices often assume this "crossover" from Medicare to the secondary payer happens automatically. It doesn't—at least not reliably. Crossover claims can fail for dozens of reasons: outdated secondary insurance information, payer system errors, coordination of benefits issues. When crossover fails, you're stuck trying to collect that 20% from the patient, which is awkward for seniors on fixed incomes and has terrible collection rates (typically 40-50% vs. 95%+ from insurance). We manually verify every Medicare claim's crossover status and intervene immediately when secondary claims don't process, ensuring you collect the full allowed amount rather than writing off thousands in secondary insurance payments.
Nevada-Specific Geriatric Billing Challenges
Las Vegas geriatric practices face unique billing complexities that national billing companies often mishandle. Nevada's healthcare landscape requires specialized local expertise to maximize Medicare revenue.
Managed Medicare Advantage Penetration
Nevada has one of the highest Medicare Advantage enrollment rates in the nation, with over 55% of Medicare beneficiaries enrolled in MA plans rather than traditional Medicare. Health Plan of Nevada (HPN), SilverSummit Healthplan, and Humana dominate the Las Vegas market, and each has different authorization requirements, billing procedures, and claims submission protocols than traditional Medicare. CCM billing requirements vary by plan—some Nevada MA plans require prior authorization for CCM services, while traditional Medicare does not. We maintain current knowledge of each plan's specific requirements and ensure your practice is credentialed and billing correctly across all payers.
Dual-Eligible Beneficiaries and QMB Status
Nevada has a substantial population of dual-eligible beneficiaries who qualify for both Medicare and Medicaid, as well as Qualified Medicare Beneficiaries (QMB) who have Medicaid coverage of their Medicare premiums and cost-sharing. These patients qualify for the highest tier of Advanced Primary Care Management (APCM code G0558), which pays $117 monthly compared to $54 for standard APCM. However, identifying QMB patients requires checking Nevada Medicaid eligibility in addition to Medicare status, a step most practices skip. We perform dual eligibility verification for your entire panel and identify QMB patients who qualify for premium APCM reimbursement.
Las Vegas Senior Population Density
Las Vegas's senior population (15.6% over age 65 compared to 12.9% nationally) creates intense competition among geriatric practices. This demographic concentration means practices that fail to optimize Medicare billing are leaving significant revenue on the table in a market where every dollar of reimbursement matters. The practices that succeed in Las Vegas are those capturing CCM, AWV, and TCM revenue systematically—not just the practices with the most patients, but the practices with the best billing operations.
Nevada Medicaid MCO Complexity
For geriatric practices serving dual-eligible patients, understanding Nevada's Medicaid Managed Care Organization landscape is essential. SilverSummit Healthplan, Health Plan of Nevada Medicaid, CareSource Nevada, and Molina Healthcare of Nevada each have different prior authorization processes, claims submission requirements, and appeals procedures. A claim that would be paid automatically under traditional Medicare might require prior auth under one MCO but not another. We navigate these Nevada-specific requirements so your dual-eligible patients generate appropriate revenue rather than denial-and-appeal cycles.
Real Results: Las Vegas Geriatric Practice Adds $180k Annually
A 2-provider geriatric practice in Henderson with approximately 800 Medicare patients approached us after struggling with declining reimbursement and increased administrative burden. They were billing only face-to-face E/M visits with a 93% collection rate but capturing none of the non-face-to-face revenue their complex patient panel qualified for.
Our implementation: We identified 180 patients meeting CCM criteria (2+ chronic conditions with documented care coordination needs), implemented systematic AWV scheduling protocols, and established TCM tracking for all hospital and SNF discharges. Critical to success was training their existing medical assistants to document CCM time properly and establishing clear workflows that didn't disrupt clinical operations.
Total new annual revenue: $206,000. After our 6% service fee, the practice netted an additional $180,340 annually. This revenue came from the same patient panel, same visit volume, and same clinical staff—just better billing for work they were already performing. The practice added no new overhead and the physicians reported that improved care coordination actually reduced their after-hours phone calls because patients were receiving proactive monthly outreach.
Why We Are Different
Medigap Crossover Experts
Seniors often have secondary coverage (AARP, United, Mutual of Omaha). We ensure the "crossover" from Medicare to the secondary payer happens automatically, so you don't get stuck chasing the 20% coinsurance. Our team manually verifies crossover claim status and intervenes when secondary claims fail, protecting your revenue from patient collection risk.
Audit-Proof Documentation
Medicare audits are rising. We ensure your documentation for "Time-Based Billing" is bulletproof, protecting you from clawbacks on complex E/M codes (99214/99215) and CCM services. Our documentation templates include the specific language Medicare auditors require, and we train your staff on compliant activity logging that will withstand scrutiny.
Telehealth Compliance
Telehealth rules for seniors change constantly. We verify the specific "Place of Service" codes (02 vs 10) to ensure your virtual check-ins get paid. We stay current on Medicare telehealth policy changes and update your billing protocols immediately when regulations shift, preventing denials from outdated telehealth coding.
No "Senior Moment" Write-Offs
We treat patient statements with sensitivity but firmness. Our US-based team explains bills clearly to seniors, reducing confusion and increasing patient payment rates. We understand that geriatric patients may need extra time and clearer explanations, and our approach balances compassion with effective revenue collection.
CCM Program Implementation
We don't just bill CCM—we help you build the infrastructure. From patient consent workflows to time-tracking systems to staff training on documentation requirements, we provide turnkey CCM implementation that generates compliant, audit-resistant revenue. Our approach integrates with your existing EHR and clinical workflows.
AWV Systematic Scheduling
We implement automated AWV outreach systems that identify eligible patients, generate outreach lists, and integrate AWV scheduling into your existing appointment workflows. Our protocols ensure maximum AWV completion rates without overwhelming your schedule or requiring additional staffing.
Frequently Asked Questions
Stop Leaving Medicare Money on the Table.
Get a free "Missed Code" analysis for your geriatric practice.
We'll review your current billing patterns and show you exactly how much CCM, AWV, and TCM revenue you're missing. No obligation—many practices use our analysis to improve their in-house operations.
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Call (702) 715-7945 | Email: admin@a-zmedicalbilling.com
Serving geriatric practices nationwide from Las Vegas, Nevada