RE: the new medicare physical- help

[Guest guest]

This is what we do….

If the patient comes in, specifically

asking for a physical, then we do a “preventive exam.” Steve goes

over all of the preventive stuff with the patient…mammo, labs, quit

smoking, whatever….and he also addresses the hypertension, diabetes,

etc. We code it as a preventive because that’s what the patient asked

for and that’s what we did. Likely that the patient will have to come

back within the year anyways for follow-up. If, however, the patient was

scheduled for a preventive and they sprained their finger or have a cough or

something acute, then we would add the office visit with a -25 modifier and

pray that we would get paid.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of

Sent: Friday, January 28, 2011

6:26 AM

To:

Subject:

the new medicare physical- help

Hi

I know the code for the new medicare physical

I know the reimbursement

I looked on cms' website, but still

but am not sure about--

if this is a patietn ofmine coming in soon who has just figured out

that she in entiteld to a " physcial " but she has diagnoses, this

is unlikley to be a well person exam

A why istn;t it just and e and m 99214 or whatever level....?

B is this a case of -25 for the e and M part?

egads. thanks if you know'

--

MD

Farmington

ME 04938

ph fax

impcenter.org

[Guest guest]

Look at the requirements for a G0438 &

9. Look for MLN Matters Number MM7079 on the CMS website. It details what has

to be done for the “Personalized Prevention Plan Services.” My understanding

is that G0438 is for the first medicare physical that you do on a patient and

that G0439 is for the annual visits thereafter.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of

Sent: Friday, January 28, 2011

9:05 AM

To:

Subject: Re:

the new medicare physical- help

oh I got through to them! I found after three

tries and alot of phone menus- a number!! And they said add the 99214

with a modifer -25 to the annual wellness codeG0439 for established

and g0438 for new and they wi l pay both

well well.

Ya think so ?

well

she is asking for her meds to be renewed and chronic conditions re

eval'd and says well she can get a physical for free so I am

thinking it is a usual take care of her visit and certainly address

preventive but probably code the e and m also- does medicare pay

for both do we know that yet? I tried to cal lthem but they were

not open til 10 am and I have patietns to go see....

On Fri, Jan 28, 2011 at 10:18 AM, Pratt

wrote:

This is what we do….

If the patient comes in, specifically asking

for a physical, then we do a “preventive exam.” Steve goes over all of

the preventive stuff with the patient…mammo, labs, quit smoking, whatever….and

he also addresses the hypertension, diabetes, etc. We code it as a

preventive because that’s what the patient asked for and that’s what we

did. Likely that the patient will have to come back within the year

anyways for follow-up. If, however, the patient was scheduled for a

preventive and they sprained their finger or have a cough or something acute,

then we would add the office visit with a -25 modifier and pray that we would

get paid.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From:

[mailto: ]

On Behalf Of

Sent: Friday, January 28, 2011

6:26 AM

To:

Subject:

the new medicare physical- help

Hi I know the code for the new medicare

physical

I know the reimbursement

I looked on cms' website, but still

but am not sure about--

if this is a patietn ofmine coming in soon who has just figured out

that she in entiteld to a " physcial " but she has diagnoses, this

is unlikley to be a well person exam

A why istn;t it just and e and m 99214 or whatever level....?

B is this a case of -25 for the e and M part?

egads. thanks if you know'

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

[Guest guest]

The problem with the “annual wellness visit” is that the published Medicare guidelines for it is not what the patients expect. And, since they are told it is “free,” they do not expect to pay any co-insurance or deductible for services done during that visit. I am working on a web page that will explain this to patients, and that they will have to agree to in order to schedule a visit. I hope to get it completed this weekend. My plan is for as much of the data gathering as possible to be done with Instant Medical History, so the appropriate and required standard screening tests are completed before the visit, and to have a “Medicare annual wellness visit” template in my EMR that will simply the “written screening schedule” that must be given the patients as well the “list of risk factors” and referral for intervention that is required. The patients will have to acknowledge up front that they understand that no management of any disease they are known to have and that no blood tests for management of known disease are included in the “annual wellness visit,” so they will be expected to pay their coinsurance and deductibles for that part of the exam that deals with any medical issues or symptoms they may have that are not related to the Medicare-mandated screening. I fully intend to use both the E & M codes and the Medicare wellness codes for the visits, if I actually examine a patient or treat any disease. We are already getting multiple calls about this, and patients are arguing with us about how they are supposed to get a “free” exam. One man called Wednesday to schedule and was very upset when we explained what the “wellness” exam really was. He claimed that his wife had a “full physical exam with multiple tests” at a local hospital-owned clinic, and that she didn’t have to pay a cent. He called back the next day, sheepishly admitting that he had looked into it further, and that she didn’t have to pay anything because Medicare had denied payment for everything she had done (because the required criteria were not met), and the clinic had to write off the entire exam since they had not given her a ABN for the exam. dts From: [mailto: ] On Behalf Of Sent: Friday, January 28, 2011 9:05 AMTo: Subject: Re: the new medicare physical- help oh I got through to them! I found after three tries and alot of phone menus- a number!! And they said add the 99214 with a modifer -25 to the annual wellness codeG0439 for established and g0438 for new and they wi l pay both well well. Ya think so ?well she is asking for her meds to be renewed and chronic conditions re eval'd and says well she can get a physical for free so I am thinking it is a usual take care of her visit and certainly address preventive but probably code the e and m also- does medicare pay for both do we know that yet? I tried to cal lthem but they were not open til 10 am and I have patietns to go see.... This is what we do…. If the patient comes in, specifically asking for a physical, then we do a “preventive exam.” Steve goes over all of the preventive stuff with the patient…mammo, labs, quit smoking, whatever….and he also addresses the hypertension, diabetes, etc. We code it as a preventive because that’s what the patient asked for and that’s what we did. Likely that the patient will have to come back within the year anyways for follow-up. If, however, the patient was scheduled for a preventive and they sprained their finger or have a cough or something acute, then we would add the office visit with a -25 modifier and pray that we would get paid. PrattOffice ManagerOak Tree Internal Medicine P.Cwww.prattmd.info From: [mailto: ] On Behalf Of Sent: Friday, January 28, 2011 6:26 AMTo: Subject: the new medicare physical- help Hi I know the code for the new medicare physical I know the reimbursementI looked on cms' website, but still but am not sure about-- if this is a patietn ofmine coming in soon who has just figured out that she in entiteld to a " physcial " but she has diagnoses, this is unlikley to be a well person exam A why istn;t it just and e and m 99214 or whatever level....? B is this a case of -25 for the e and M part? egads. thanks if you know'-- MD ph fax impcenter.org-- MD ph fax impcenter.org-- MD ph fax impcenter.org

[Guest guest]

I agree with Don's assessment - this is what we are experiencing,

with a similar plan.

I found an article in the recent issue of Family Practice Management

with templates for this service (JanFeb 2011 - if anyone has online

access perhaps they can post).

Steve Hersch MD

MeducationPC

Ashland, OR

The problem with the “annual

wellness visit” is that the published

Medicare guidelines for it is not what the

patients expect. And, since they are told it is

“free,” they do not expect to pay any co-insurance or

deductible for services done during that visit. I am

working on a web page that will explain this to

patients, and that they will have to agree to in order

to schedule a visit. I hope to get it completed this

weekend. My plan is for as much of the data gathering

as possible to be done with Instant Medical History,

so the appropriate and required standard screening

tests are completed before the visit, and to have a

“Medicare annual wellness visit” template in my EMR

that will simply the “written screening schedule” that

must be given the patients as well the “list of risk

factors” and referral for intervention that is

required.

The patients will have to

acknowledge up front that they understand that no

management of any disease they are known to have and

that no blood tests for management of known disease

are included in the “annual wellness visit,” so they

will be expected to pay their coinsurance and

deductibles for that part of the exam that deals with

any medical issues or symptoms they may have that are

not related to the Medicare-mandated screening. I

fully intend to use both the E & M codes and the

Medicare wellness codes for the visits, if I actually

examine a patient or treat any disease.

We are already getting multiple

calls about this, and patients are arguing with us

about how they are supposed to get a “free” exam. One

man called Wednesday to schedule and was very upset

when we explained what the “wellness” exam really was.

He claimed that his wife had a “full physical exam

with multiple tests” at a local hospital-owned clinic,

and that she didn’t have to pay a cent. He called

back the next day, sheepishly admitting that he had

looked into it further, and that she didn’t have to

pay anything because Medicare had denied payment for

everything she had done (because the required criteria

were not met), and the clinic had to write off the

entire exam since they had not given her a ABN for the

exam.

dts

From:

[mailto: ] On

Behalf Of

Sent: Friday, January 28, 2011 9:05 AM

To:

Subject: Re: the new

medicare physical- help

oh I got through to them! I found after three

tries and alot of phone menus- a number!! And

they said add the 99214 with a modifer -25 to the

annual wellness codeG 0439 for established and

g0438 for new and they wi l pay both

well well.

Ya think so ?

On Fri, Jan 28, 2011 at 11:06

AM,

wrote:

well

she is asking for her meds to be renewed and

chronic conditions re eval'd and says well she

can get a physical for free so I am thinking it

is a usual take care of her visit and certainly

address preventive but probably code the e and

m also- does medicare pay for both do we know

that yet? I tried to cal lthem but they were

not open til 10 am and I have patietns to go

see....

On Fri, Jan 28, 2011 at

10:18 AM, Pratt

w rote:

This is what we do….

If the patient comes

in, specifically asking for a

physical, then we do a

“preventive exam.” Steve goes

over all of the preventive

stuff with the patient…mammo,

labs, quit smoking,

whatever….and he also

addresses the hypertension,

diabetes, etc. We code it as

a preventive because that’s

what the patient asked for and

that’s what we did. Likely

that the patient will have to

come back within the year

anyways for follow-up. If,

however, the patient was

scheduled for a preventive and

they sprained their finger or

have a cough or something

acute, then we would add the

office visit with a -25

modifier and pray that we

would get paid.

Pratt

Office Manager

Oak Tree

Internal Medicine P.C

www.prattmd.info

From:

[mailto: ]

On Behalf Of Jean

Antonucci

Sent: Friday, January

28, 2011 6:26 AM

To:

Subject:

the

new medicare physical- help

Hi I know

the code for the new

medicare physical

I know the

reimbursement

I looked on cms'

website, but still

but am not sure

about--

if this is a patietn

ofmine coming in soon

who has just figured

out that she in

entiteld to

a"physcial" but she

has diagnoses, this

is unlikley to be a

well person exam

A why istn;t it just

and e and m 99214 or

whatever level....?

B is this a case of

-25 for the e and M

part?

egads. thanks if you

know'

--

MD

115 Mt Blue

Circle

Farmington ME

04938

ph fax

impcenter.org

--

MD

ph fax

impcenter.org

--

MD

ph fax

impcenter.org