March 2011 Client Newsletter
New Medicare wellness visits
Medicare has redefined the G0402 (Initial Preventive Physical Exam). It is now valid for 12 months (it was 6 months) after the patient becomes eligible for Medicare (not the previous 6 months).
For new Medicare patients joining your practice, you will want to verify whether they received a previous well visit (G0402 now, or G0438/G0439 next year) with a previous provider before you provide that service. If so, you will need to know exactly when it was received since a full 11 months (12 months is safer) must pass before billing the subsequent AWV code. If there is any doubt, you could have the patient sign an ABN, tho technically none is required.
The AAFP has also developed some tools to assist with meeting the AWV documentation requirements and clarify some Frequently Asked Questions. These have been emailed to all of our PCP clients. If you did not receive a copy, call Rich and we will send to you.
Medicare learning network information
To assist our PCP’s who are taking advantage of the new Medicare Wellness codes, we have ordered several documents from CMS that provide details about the program and included them & a CD in this month’s mailing:
· “Medicare Preventive Services Quick Reference Informationâ€
· “Smoking and Tobacco-Use Cessation Counseling Servicesâ€
· A CD entitled “Medicare Preventive Services Resourcesâ€
For other providers who qualify for the CMS EMR bonus, a brochure entitled
· “Medicare Electronic Health Record Incentive Program for Eligible Professionalsâ€
is also enclosed available. CPB has the names of both free and inexpensive EMR programs if you want to see those products. We are also happy to provide information to help you with selection and installation to minimize cash-flow disruption. I have attended 3 EMR conferences - this is a SIGNIFICANT event for your practice that will require careful planning to implement correctly. As of 6 months ago, we were hearing that 74-76% of installations were either not being used after 1 year (in some cases were uninstalled) or only being partially used. You should strongly consider taking the time to review 3-4 programs before selecting one. There are a lot of things to consider – feel free to call if you want to discuss.
Medicare 2011 ePRESCRIPTION (eRx) & PQRI
To avoid a 1% decrease in Medicare reimbursement in 2012 eligible providers MUST become an eRx prescriber no later than 6/30/11 by submitting at least 10 events on claims using a “qualified†eRx system. The decrease becomes 1.5% in 2013. CPB has updated all Charge forms to include the eRx code – be sure to circle or “check†it so we send it with your other charges.
You can receive either the eRx or the EHR incentives, but not both. One of the EHR requirements is eRx capability, so Medicare will not pay twice for having the capability.
TRICARE NON-COVERED SERVICES
Similar
to Medicare’s Advanced Beneficiary Notice (ABN), TriCare has their own
form to use when the patient’s signature is required for a product or
service that is not covered. And just as with Medicare, a patient with
TriCare must have a written agreement to pay for a non-covered service
or supplies before receiving it.
A copy of the “TriCare Non-Covered Services Waiver†form is attached.
The following items are from the TriCare Policy Manual (edited to include only services we recognize our clients provide):
31. Removal of corns or calluses or trimming of toenails and other routine podiatry services, except those required as a result of a diagnosed systemic medical disease affecting the lower limbs, such as severe diabetes (see Chapter 8, Section 11.1).
37. Preventive care, such as routine annual, or employment-requested physical examinations; routine screening procedures; immunizations; except as provided in the Preventive Services policy (see Chapter 7, Sections 2.1, 2.2, 2.5, 2.6 and Chapter 12, Section
2.2).
38. Services of chiropractors and naturopaths whether or not such services would be eligible for benefits if rendered by an authorized provider (see Chapter 7, Section 18.5).
49. Orthopedic shoes, arch supports, shoe inserts, and other supportive devices for the feet, including special-ordered, custom-made built-up shoes, or regular shoes later built up (see Chapter 8, Sections 3.1 and 11.1).
A copy of the “TriCare Non-Covered Services Waiver†form is attached.
The following items are from the TriCare Policy Manual (edited to include only services we recognize our clients provide):
31. Removal of corns or calluses or trimming of toenails and other routine podiatry services, except those required as a result of a diagnosed systemic medical disease affecting the lower limbs, such as severe diabetes (see Chapter 8, Section 11.1).
37. Preventive care, such as routine annual, or employment-requested physical examinations; routine screening procedures; immunizations; except as provided in the Preventive Services policy (see Chapter 7, Sections 2.1, 2.2, 2.5, 2.6 and Chapter 12, Section
2.2).
38. Services of chiropractors and naturopaths whether or not such services would be eligible for benefits if rendered by an authorized provider (see Chapter 7, Section 18.5).
49. Orthopedic shoes, arch supports, shoe inserts, and other supportive devices for the feet, including special-ordered, custom-made built-up shoes, or regular shoes later built up (see Chapter 8, Sections 3.1 and 11.1).
If you want to see more details of the above policies, let me know.