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

Healthchek School-Based Services Available Throughout Ohio

The Ohio Department of Medicaid and Buckeye Health Plan encourage the use of school-based services to ensure students are healthy and engaged, which enables a better overall learning experience.

School-based health in Ohio ranges from large school health centers that houses full-time medical staff to smaller, part-time clinics that may only have one staff member. Services include primary care (TB testing, annual and sports physicals, hearing and vision screening, immunizations, etc.), oral health, mental healthcare services, and other wrap-around services to promote health and safety.

For a full listing of services, please visit the Ohio Department of Education’s health care support toolkit: Ohio-toolkit-Vision-for-school-based.pdf.aspx.