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Monday, November 22, 2010

Medicare preventive services: Are your patients calling?

From what I am hearing, your offices may already be getting requests from Medicare patients to schedule an appointment for the new  annual wellness visit that Medicare will begin covering on Jan. 1, 2011. We'll be bringing you a full article on this and other changes to Medicare coverage of preventive services in the January/February 2011 issue of Family Practice Management. A new encounter form for Medicare preventive service visits is also being developed.

Here are a few tips that you might want to know before scheduling appointments for annual wellness visits:

  1. Patients are being encouraged to get this service, and Part B pays at 100 percent with no out-of-pocket costs to the patient.
  2. Your staff need to verify the patient's Medicare Part B eligibility date. Patients in their first 12 months of Medicare Part B coverage are eligible for the Welcome to Medicare physical, not the new annual wellness visit.
  3. Patients who have received a Welcome to Medicare physical are not eligible for an annual wellness visit until 12 months after the date they received the Welcome to Medicare physical. If the patient has been eligible for Medicare Part B for more than 12 months but less than 24, staff should verify if and when a Welcome to Medicare physical was provided.
  4. The annual wellness visit includes a few things that the Welcome to Medicare physical does not, including:
    • A requirement to collect information on all other physicians and suppliers currently providing care to the patient,
    • An assessment of cognitive function,
    • Development of a five- to 10-year plan for obtaining recommended preventive care,
    • A list of patient risk factors that you've identified, with current or proposed treatment options including the benefits and risks associated with these options.
  5. Medicare will allow a significant and separately identifiable evaluation and management (E/M) service on the same date as the annual wellness visit when it is reported with a modifier 25. However, the Centers for Medicare & Medicaid Service (CMS) recommends against providing non-urgent acute care at the same encounter, as it may detract from the intended focus on preventive care. Patients may not appreciate making two visits, but providing information at the time of scheduling to advise patients that an annual wellness visit does not include treatment or management of problems may set expectations and limit frustration.
  6. The initial annual wellness visit payment is equal to a level-four new patient visit. Don't underestimate the time needed to provide and document these services. You may want to work with your scheduling and clinical support staff to establish new processes so that the history and other portions of the service that don't require a physician's skills can be performed and ready for your review before your with the patient begins. It will also be important to remind patients to come prepared to provide information on all the medications, supplements and vitamins they take and their personal and family history.

These services will no doubt be of benefit to Medicare patients who might otherwise not seek care beyond that for existing or bothersome new conditions. However, this ounce of prevention may feel like a ton of work for you and your staff, particularly if you don't plan ahead.

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.

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