Specialties / Primary care
Primary care billing, done for you
For family and internal medicine. Your clinicians document the visit. We code it (visit level, modifier 25, G2211, wellness visits, chronic care management), check it and see it paid. You keep your EMR and see every claim live.
Live for family and internal medicine practices.
The rules we code and check before a primary care claim goes out
We code the level the note supports, never higher.
| Rule | What it means | What we check | Who decides |
|---|---|---|---|
| Office visit level | Office visits (99202 to 99215) are leveled by medical decision making or by the clinician's total time on the date of the visit. When time is used, time beyond the highest level is billed with G2212. | The level matches the documented decision making, or the documented total time | Mohenara codes from your clinician's note and never upcodes; your clinician documents |
| Modifier 25 | Marks a significant, separately identifiable visit by the same clinician on the same day as a procedure or another service, such as a problem addressed during a wellness visit. A different diagnosis is not required. | 25 only when the note shows a separate problem and work beyond the other service | Mohenara codes from your clinician's note |
| G2211 add-on | Medicare's add-on to an office visit when the clinician is the patient's continuing focal point for care, or treats a serious or complex condition over time. Not paid when the visit carries modifier 25, except with a wellness visit, a vaccine administration or a Part B preventive service. | G2211 only with an office or home visit, and with 25 only alongside an allowed preventive service | Mohenara codes from the visit and your patient's history with your practice |
| Medicare wellness visits | The Welcome to Medicare visit (G0402) within the first 12 months of Part B. The annual wellness visit once every 12 months: G0438 the first time, once in a lifetime, then G0439. Never billed as 99381 to 99397. The patient pays nothing when the practice accepts assignment. | The right G code for the patient's history, and the last wellness visit date before the visit | Mohenara codes from the note; the eligibility check shows the last wellness visit |
| Routine physicals | Medicare does not cover a routine physical (99381 to 99397). When a covered problem visit happens at the same time, Medicare pays that visit and the patient can be charged the rest of the physical. Commercial plans set their own preventive benefits. | For Medicare, a covered visit billed only when the note shows a separate problem; the rest of the physical billed to the patient | Your front desk explains the patient's share and gets an Advance Beneficiary Notice (ABN) signed when needed; Mohenara codes from the note |
| Chronic care management | For patients with 2 or more chronic conditions expected to last 12 months or more. 99490 for the first 20 minutes of clinical staff time in a month and 99439 for each further 20; 99491 for 30 minutes of the clinician's own time. The patient's consent comes first, and only one practitioner bills it each month. | Consent on file, minutes logged for the month, no other practitioner billing it | Your clinicians and staff document the time and consent; Mohenara bills it once the month's minutes are met |
| Timely filing | Medicare: one calendar year from the date of service. Other payers set their own. | Each payer's deadline tracked; aging claims worked before it | Mohenara |
Medicare updates visit codes and add-on rules each January with its fee schedule.
Before the visit
Software
Automated check
- Coverage active, plan dates, copay, coinsurance and deductible, as the insurance company returns them.
- The last Medicare wellness visit date, so a visit too early is caught before it is booked as one.
- An answer the payer leaves incomplete stays unknown, never zero.
Software
Tracking
- Visits used against visits approved, and authorization end dates.
- Chronic care management minutes logged this month.
You
Your front desk
- Fixes insurance cards and details in your EMR.
- Requests authorizations.
- Explains a routine physical's cost to Medicare patients and gets an Advance Beneficiary Notice (ABN) signed when needed.
- Collects copays.
A coverage check is not a guarantee of payment.
What you see in your dashboard
Every visit claim as it moves: sent, paid, denied or waiting on you, and the money in your bank.
Your dashboard, Money: collected, in your bank and owed, live.See every view of your dashboard
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