"Welcome to Medicare" - What you need to know.

I came across this article information from a website called "Manage my Practice"  

http://www.managemypractice.com/why-you-cant-get-an-annual-medicare-physical/#more-13471

This is a brief exerpt from the article, but it clearly outlines what we need to understand as Coders for our Medicare patient's in our practice.  This has really cleared up the confusion for me, and hopefully will help you...  help your patients to understand what CMS Medicare will and will not pay for.  and as always... Happy Coding!





".....The only answer is to help patients understand what Medicare will and will not pay for and to try to match their benefits, their needs and what they are willing to pay for.
Here are the service choices defined by CMS/Medicare: "

NAME: Welcome to Medicare Visit

WHEN: Available to all Medicare patients during the first 12 months of Medicare Part B eligibility
WHAT HAPPENS: Review of patient’s medical history, risk factors, functional abilities and referrals for education or counseling. Could include an EKG or referral for an EKG. Could include screening for an
abdominal aortic aneurysm (AAA). Does not include a physical exam.
WHO PAYS: This visit has no deductible and no co-insurance, unless the patient has a screening EKG. The EKG does have the deductible and co-insurance applied.

NAME: Annual Wellness Visit

WHEN: Available 12 months after the Welcome to Medicare Visit and every 12 months thereafter
Does not include a physical exam.
WHAT HAPPENS: Review of your medical history, risk factors, functional abilities, a depression screening and a written screening schedule.
WHO PAYS WHAT: This visit has no deductible and no co-insurance.

NAME: Sick Visit (standard office visit)

WHEN: No restrictions on how often as long as there is a documented need for the visit.
WHAT HAPPENS: This is a regular office visit for an illness, injury or new problem or for monitoring of an existing problem. The three parts of a standard office visit are the HISTORY, the PHYSICAL EXAM, and the ASSESSMENT/PLAN.
WHO PAYS WHAT: This visit will apply to the deductible ($147 for 2013) if the patient’s deductible has not been met, and co-insurance will apply.




The only answer is to help patients understand what Medicare will and will not pay for and to try to match their benefits, their needs and what they are willing to pay for.
Here are the service choices defined by CMS/Medicare: