Medicare Wellness. Meggan Robinson, DO MAOFP Spring Update 4/23/16

Size: px
Start display at page:

Download "Medicare Wellness. Meggan Robinson, DO MAOFP Spring Update 4/23/16"

Transcription

1 Medicare Wellness Meggan Robinson, DO MAOFP Spring Update 4/23/16

2 Objectives History of Medicare Wellness Exam Identify the goals of the Wellness exam Differentiate the different types of Wellness exams Learn what is included and covered? Review basic preventive guidelines supported by the USPSTF Codes for billing

3 I have no disclosures! Disclosures

4

5 Affordable Care Act Signed into law March 23, 2010 Insurance plans must provide coverage for preventive care and medical screenings rated A or B by the USPSTF. Insurers are prohibited from charging copays, co-insurance, or deductibles for these services Jan 1, 2011-Medicare offers Annual Wellness Visits

6 Goals of Wellness Visits Health Promotion Disease Prevention Detection Among adults 65 & older, only 33% of women & 40% of men are UTD with all age-specific recommended services.

7 Types of Wellness Visits 1. Welcome to Medicare preventive visit IPPV-Initial Preventive Physical Exam G Yearly Wellness Visits Initial AWV (Annual Wellness Visit)- G0438 Subsequent AWV- G0439

8 Who s Eligible? All people with Medicare Part B are covered. If additional tests or services are ordered during a wellness visit that are not covered under preventive benefits, pt may have to pay coinsurance or deductible may apply.

9 Welcome To Medicare What s Included Review of medical, family, social history Height, Weight, Blood pressure, BMI Vision Test Depression Screen Level of Safety Advanced Directives Counseling education/preventive services Formulated plan: including screenings, immunizations, other preventive services

10 Annual Wellness Visit What s included Pt to complete HRA Height, weight, BMI, Blood Pressure Review medical, social, family history Develop an undated list of providers and prescriptions Depression Screen Functional Ability and Level of safety Detection of cognitive impairment Counseling/Education Formulated Plan: Including screening, immunizations, preventive services

11 Where is the Physical Exam? Height, Weight, BMI, and blood pressure Other routine measurements as deemed appropriate based on medical and family history (medicare.gov) Other factors deemed appropriate based on medical and social history and current clinical standards (cms.gov)

12 HRA Collects self reported information from the beneficiary At a minimum collects: Demographic Data Self reported health Psychosocial and Behavioral Risks ADLs

13 Case 1 65 yo AA M who is presenting for his Welcome to Medicare Visit PMH: HTN, DMII Meds: Metformin 500mg BID, Lisinopril/HCTZ, ASA Social Hx: Smoker 1ppd x 40 years-quit 5 years ago, Etoh-1-2 beers/week FH: CAD, DM Vitals: Height 5ft 7in, Weight 193lb, BMI-30, BP 112/70

14 Review Hx Review Mr. Wells medications, social history, family history Hospitalizations Diet/Exercise Functional Ability-Denies hearing difficulties/unlimited ADLs Fall Risk Factors-Antihypertensive use, Loose Rugs

15 Depression/Cognitive Impairment Screen PHQ-2 Over the past 2 weeks, Have you felt down, depressed, or hopeless? Over the past 2 weeks, Have you felt little interest or pleasure doing things? Pt denies difficulty learning/retaining new info, difficulty with behavior or language, reasoning or complex tasks.

16 Advance Directives Living will, DPOA, Advance Directives? Reviewed end of life decisions with pt

17 Physical Exam Vitals Vision Test- Acuity 20/50 b/l Get up and Go? Your choice of further exam

18

19 Once in a lifetime screening EKG-1 time screening Diagnostic EKGs are different AAA Screening- For those at risk 1. Family History 2. Male age and have smoked 100 cigarettes in lifetime

20 Preventive/Screening Services Cardiovascular Screening Lipid panel every 5 years Diabetes Screening-Cover 2 per year If there are risk factors- HTN, Dyslipidemia, Obesity, History of elevated BG Or if 2 or more of the following: Age > 65 Overweight Family Hx DM Gestational DM or baby > 9lb

21 Preventive/Screening Services Lung Cancer Screening Low dose CT scan- 1/year Must meet ALL criteria 55-77yo Asymptomatic (no signs or symptoms of lung ca) Current smoker or quit in the past 15 years 30 pack year smoking history

22 Preventive/Screening Services Colon Cancer Screening If normal risk-colonoscopy every 10 years for 50 year old and greater Flex sig every 3 years Barium enema every 3 years FOB every year Stool DNA testing-every 3 years for those that meet ALL criteria

23 Preventive/Screening Services Colon Cancer Screening Stool DNA testing criteria: yo 2. No signs or symptoms of colorectal disease (Lower abd pain, blood in stool, +FOB) 3. Average risk- No history of adenomatous polyps, CRC, or IBD. No family history of hereditary conditions.

24 Preventive/Screening Services Prostate Cancer Screening PSA every 12 months DRE every 12 months

25 Preventive/Screening Services Immunizations Influenza- 1 per season Shingles Vaccine- No covered under Part A or B Tdap-Not covered under Part A or B Pneumococcal vaccines- Prevnar (PCV13) and Pneumovax (PPSV23)- both covered and recommended for age >65. Hep B-Covered for those at moderate to high risk.

26 Preventive/Screening Services STI screening Chlamydia, gonorrhea, syphilis, HIV, Hep B screenings are covered yearly for sexually active adults at risk for STI s.

27 Case 1 Recap Mr. Wells was encouraged to continue his healthy diet and active lifestyle. Fall prevention discussed. He was advised to fill out Advance Directive AAA screening and EKG done today Influenza and Prevnar immunizations given Lipid profile and PSA ordered UTD on colonoscopy, Declined further Lung cancer screenings Referred to Eye doctor for annual HTN/DM eye exam

28 Case 1 Recap Billed G0402 Diagnosis Code of V70.0

29 Case 2 67 yo Caucasian F who presents for her AWV PMH: Osteoporosis, OA Meds: Fosamax, Tramadol Social Hx: 5 pack year smoking hx, no etoh, no illicits Family Hx: DM, HTN, Stroke, CAD Pt has new complaint of elbow pain today. Vitals: 5ft 3in, 143lb, BMI 25, BP 140/46

30 Review Hx Review Mrs. Robertson s medications, social, family history Hospitalizations Diet/Exercise Depression Screen-Negative Functional Ability and Level of Safety-Normal ADLs Cognitive Impairment-Denies Update Advance Directive if needed

31 Physical Exam Vitals Vision Test? Get up and go? Your choice of physical exam.

32 Preventive/Screening Services Once in a lifetime screening AAA EKG

33 Preventive/Screening Services Bone Mineral Density Testing Covered every 24 months (more often if medically necessary) At risk: Woman who are estrogen deficient & at risk Any person with an xray-osteoporosis/osteopenia/fractures Any person taking chronic steroids or planning to begin Dx of primary hyperparathyroidism Monitor to see if their osteoporosis drug is working

34 Preventive/Screening Services Cervical Cancer Screening Covers cervical/vaginal/clinical breast exams Covered every 2 years for all women Covered every 1 year for women at high risk for cervical cancer or vaginal cancer

35 Preventive/Screening Services Mammogram Every 1 year (for women 40 & older) Diagnostic mammogram when necessary but 20% deductible may apply

36 Preventive/Screening Services Mrs. Robertson Screening Checklist: Cardiovascular/Diabetes screen-lipid Panel Colonoscopy-Completed in 2010 Lung cancer screening-not Indicated Immunizations-Influenza due, Pneumovax given at 65-Prevnar can be given.

37 Case 2 Recap Mrs. Robertson advised to continue healthy diet. Activity will be addressed after PT following knee surgery. Mammogram and BMD ordered Influenza and PCV13 (Prevnar) given Rx for Zostavax given Discussed fall prevention No referrals needed. Pt will follow up for elbow pain.

38 Case 2 Recap Billed G0438 Diagnosis code of V70.0

39 FAQs Is an annual wellness visit (AWV) the same as a yearly physical? No. Medicare does not cover routine physical exams.

40 FAQs Can I bill an EKG & AWV on the same date of service? You may provide other services on the same day as AWV but pt deductible/copayment may apply for additional services.

41 FAQs How do I know if a beneficiary got their AWV through another provider? CMS suggest that providers check with Medicare Administrative Contractor (MAC) to check eligibility ( HIPAA Eligibility Transaction System (HETS) that you can check a beneficiary s next available date for AWV.

42 FAQs If a provider completes the AWV and does a comprehensive physical exam even though its not covered by Medicare, can provider elect to not bill the patient for non-covered service? CMS does not require providers to submit claims for non-covered services to the patient at no charge. CMS notes that decision whether or not to charge a patient for non-covered Medicare services is at the discretion of each provider.

43 FAQs Is an Advanced Beneficiary Notice (ABN) required for non-covered services? Not required. Good practice would be to alert patient to financial liabilities and a voluntary ABN is one way of doing that.

44 Resources American College of Physicians Acponline.org/practice-resources Family Practice Management Aafp.org/fpm/toolbox

45 References Medicare.gov CMS.gov Uspreventiveservicestaskforce.org THANK YOU!

Preventive Services Explained

Preventive Services Explained Preventive Services Explained Medicare covers many preventive care services without charge. Most of these services have been recommended by the U.S. Preventive Services Task Force. However, which beneficiaries

More information

Preventative and Immunization Brochure

Preventative and Immunization Brochure Preventative Immunization Brochure Table Of Contents 2016 Medicare Advantage Preventative Visits Guidelines... 1 Preventative Visits... 3 Common Preventive Services s*... 5 Additional Services Provided

More information

Medicare Well Patient Visits

Medicare Well Patient Visits Last First MI Type of Wellness Exam: Medicare Part B Eligibility Date: Vital signs: IPPE Welcome to Medicare Select G0402, G0403, G0404 or G0405 (1 time during first 12 months on Medicare) Medicare Well

More information

Your Guide to Medicare s Preventive Services

Your Guide to Medicare s Preventive Services Your Guide to Medicare s Preventive Services C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government booklet with important information about: What disease

More information

Medicare Preventive Services and Screenings

Medicare Preventive Services and Screenings Welcome to PMI s Webinar Presentation Brought to you by: pmimd.com Meet the Presenter Linda D'Spain, CMPE, CMC, CMIS, CMOM, CMCO On the topic: Medicare Preventive Services and Screenings Welcome to s Webinar

More information

Medicare Preventive Visit Form Office: Use this form if not using EPIC. Patient Name:

Medicare Preventive Visit Form Office: Use this form if not using EPIC. Patient Name: Medicare Preventive Visit Form Office: Use this form if not using EPIC G0402 IPPE G0438 AWV G0439 - subsequent REQUIRED EXAM Patient Name: DETAILS (Include description of all abnormal Body Mass Index Ht.

More information

Decoding the USPSTF. By: Dr Vikram Arora Heritage Valley Health System

Decoding the USPSTF. By: Dr Vikram Arora Heritage Valley Health System Decoding the USPSTF By: Dr Vikram Arora Heritage Valley Health System Objectives O Gain insight into function of USPSTF O Review grading system O Critically appraise key current recommendations of the

More information

Medicare Preventive Services. Disclosure Statement

Medicare Preventive Services. Disclosure Statement Medicare Preventive Services LCDR Tunesia Mitchell CMS/Region 2 Disclosure Statement The planners and presenters do not have any financial arrangements or affiliations with any commercial entities whose

More information

A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS

A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries

More information

Geriatric Preventive Care. Lee A. Jennings, MD, MSHS Reynolds Department of Geriatrics University of Oklahoma Health Sciences Center

Geriatric Preventive Care. Lee A. Jennings, MD, MSHS Reynolds Department of Geriatrics University of Oklahoma Health Sciences Center Geriatric Preventive Care Lee A. Jennings, MD, MSHS Reynolds Department of Geriatrics University of Oklahoma Health Sciences Center Summary of Preventive Care Lifestyle Exercise Tobacco cessation Alcohol

More information

Optima Health. Adult Health Maintenance Guidelines. Guideline History. Original Approve Date 04/93

Optima Health. Adult Health Maintenance Guidelines. Guideline History. Original Approve Date 04/93 Optima Health Adult Health Maintenance Guidelines Guideline History Original Approve Date 04/93 Review/ Revise Dates 8/94, 8/96, 6/97, 7/97, 10/98, 10/99, 5/00, 2/01,6/03, 06/05, 12/07,01/09, 1/10, 1/11,

More information

Your Guide to Medicare s Preventive Services

Your Guide to Medicare s Preventive Services Your Guide to Medicare s Preventive Services C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government booklet with important information about: What disease

More information

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over 1. BMI - Documented in patients medical record on an annual basis up to age 74. Screen for obesity and offer counseling to encourage

More information

A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS

A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries

More information

Welcome to Medicare: Exam Overview

Welcome to Medicare: Exam Overview Welcome to Medicare: Exam Overview June 8, 2016 Agenda Opening Remarks Housekeeping Polling Questions Presentations Polling Questions Q&A Closing Remarks 2 Introduction to the atom Alliance Multi-state

More information

Understanding Preventive Care

Understanding Preventive Care Understanding Preventive Care FAQs: Understanding Preventive Care At Blue Cross and Blue Shield of Vermont, (BCBSVT) we want you to get preventive care so you can find out about health problems early and

More information

Optima Health. Adult Health Maintenance Guidelines. Guideline History Original Approve Date 04/93

Optima Health. Adult Health Maintenance Guidelines. Guideline History Original Approve Date 04/93 Optima Health Adult Health Maintenance Guidelines Guideline History Original Approve Date 04/93 Review/ Revise Dates 8/94, 8/96, 6/97, 7/97, 10/98, 10/99, 5/00, 2/01,6/03, 06/05, 12/07,01/09, 1/10, 1/11,

More information

2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest.

2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. 2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date

More information

2015 National Training Program. Wo r k b o o k. Module: 7 Medicare Preventive Services

2015 National Training Program. Wo r k b o o k. Module: 7 Medicare Preventive Services 2015 National Training Program Wo r k b o o k Module: 7 Medicare Preventive Services ii Module Description Centers for Medicare & Medicaid Services (CMS) National Training Program (NTP) Instructor Information

More information

2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest.

2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. 2017 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date

More information

PREVENTIVE CARE RECOMMENDATIONS Detailed descriptions

PREVENTIVE CARE RECOMMENDATIONS Detailed descriptions PREVENTIVE CARE RECOMMENDATIONS Detailed descriptions How often and what kind of preventive care services you need depends upon your age, gender, health and family history. Not all items on this list are

More information

Medicare Preventive Services Calendar. Please punch hole to hang calendar

Medicare Preventive Services Calendar. Please punch hole to hang calendar 2016 Printer Medicare Preventive Services Calendar instructions: Please punch hole to hang calendar Welcome to Medicare Visit During the first 12 months that you have Part B, you can get a Welcome to Medicare

More information

Playing the Game: Strategies For Completing the ACO Measures

Playing the Game: Strategies For Completing the ACO Measures ACO Quality Scoring Playing the Game: Strategies For Completing the ACO Measures June 2, 2016 1 2 Quality Measure Score Primary Focus on: GPRO (Group Practice Reporting Option) Measures >50% Preventative

More information

Coverage for preventive care

Coverage for preventive care Coverage for preventive care Understanding your preventive care coverage Preventive care, like screenings and immunizations, helps you and your family stay healthier and can help lower your overall out-of-pocket

More information

Healthcare Reform Preventive Services

Healthcare Reform Preventive Services An Independent Licensee of the Blue Cross and Blue Shield Association The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue

More information

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral

More information

EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share

EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share The Affordable Care Act (ACA) requires non-grandfathered health plans in the individual and group markets to cover certain preventive/screening

More information

Subject: Preventive Services Policy Effective Date: 08/2017 Revision Date: 05/2018

Subject: Preventive Services Policy Effective Date: 08/2017 Revision Date: 05/2018 Subject: Preventive s Policy Effective Date: 08/2017 Revision Date: 05/2018 DESCRIPTION The Affordable Care Act (ACA) requires nongrandfathered health plans to cover evidence-based preventive care and

More information

Prevents future health problems. You receive these services without having any specific symptoms.

Prevents future health problems. You receive these services without having any specific symptoms. PREVENTIVE CARE To help you live the healthiest life possible, we offer free preventive services for most Network Health members. Please refer to your member materials, which you received when you enrolled

More information

Preventive care covered with no cost sharing Get checkups, screenings, vaccines, prenatal care, contraceptives and more with no out-of-pocket costs

Preventive care covered with no cost sharing Get checkups, screenings, vaccines, prenatal care, contraceptives and more with no out-of-pocket costs Quality health plans & benefits Healthier living Financial well-being Intelligent solutions NOTE: Aetna Choice follows the recommendations of the United States Preventive Services Task Force (USPSTF).

More information

The Annual Wellness Visit for Medicare Beneficiaries/PCP and Care Transitions

The Annual Wellness Visit for Medicare Beneficiaries/PCP and Care Transitions The Annual Wellness Visit for Medicare Beneficiaries/PCP and Care Transitions Optimizing Benefit for Patient and Physician Annette Carron, DO, CMD, FACOI, FAAHPM Geriatrics and Palliative Care Henry Ford

More information

2017 Preventive Schedule

2017 Preventive Schedule 2017 Preventive Schedule PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The preventive guidelines

More information

Preventive Health Guidelines for Providers

Preventive Health Guidelines for Providers Preventive Health Guidelines for Providers Sanford Health Plan has adopted the preventive care benefits as outlined under The Patient Protection and Affordable Care Act. Members can refer to their Summary

More information

2017 Preventive Health Care Guidelines

2017 Preventive Health Care Guidelines 2017 Preventive Health Care Guidelines NEXT All Adults 4 Women 6 Pregnant Women 8 Children 10 Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date

More information

Preventive Health Coverage

Preventive Health Coverage Birth to 2 Years Page 1 of 2 Wellness exams and immunizations Well-baby/well-child/well-person exams... Birth, 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months Additional visit at 3-5 days after birth and within

More information

Medicare Preventive Services

Medicare Preventive Services Medicare Preventive Services Presented by Cahaba Government Benefit Administrators, LLC Provider Outreach & Education March 24, 2010 Disclaimer This resource is not a legal document. This presentation

More information

Preventive health guidelines As of April 2012

Preventive health guidelines As of April 2012 Preventive health guidelines As of April 2012 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine

More information

Statement of Coverage. Preventive Health Services Policy. Policy Specific Section: Preventive Health Guidelines

Statement of Coverage. Preventive Health Services Policy. Policy Specific Section: Preventive Health Guidelines Statement of Coverage Preventive Health Services Policy Type: Preventive Health Guidelines Policy Specific Section: Medicine Group Plans Effective Date: September 23, 2010 * or upon renewal * Effective

More information

Date: April 1, 2015 All Keystone Health Plan Central Participating Subject: Physician Guidelines for Preventive Services

Date: April 1, 2015 All Keystone Health Plan Central Participating Subject: Physician Guidelines for Preventive Services PROFESSIONAL ADMINISTRATIVE BULLETIN: 2015P-04-001 Date: April 1, 2015 All Keystone Health Plan Central Participating Subject: Physician Guidelines for Preventive Services Professional Providers Child

More information

Preventive care guidelines for children and adults.

Preventive care guidelines for children and adults. Preventive care guidelines for children and adults. Keeping a focus on regular preventive care can help you and your family stay healthy. Preventive care can help you avoid potentially serious health conditions

More information

Even if feeling fine, it s important to have regular check-ups with a health care provider. These visits may help prevent future problems.

Even if feeling fine, it s important to have regular check-ups with a health care provider. These visits may help prevent future problems. Even if feeling fine, it s important to have regular check-ups with a health care provider. These visits may help prevent future problems. For example, the only way to find out if you have high blood pressure

More information

DETAILED 2014 PREVENTIVE CARE SERVICES

DETAILED 2014 PREVENTIVE CARE SERVICES DETAILED 2014 PREVENTIVE CARE SERVICES How often and what kind of preventive care services you need depends upon your age, gender, health and family history. Your provider determines whether services delivered

More information

SCHEDULE OF BENEFITS PLAN M7

SCHEDULE OF BENEFITS PLAN M7 SCHEDULE OF BENEFITS PLAN M7 Effective September 1, 2017 When you need to see a physician, a physician network, PHCS, is utilized for all physician services (primary care and specialists) and ancillary

More information

2013 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society October 3, 2013

2013 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society October 3, 2013 2013 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society October 3, 2013 Joy Pelfrey, RN, MSN, FNP, NEA-BC Director of Senior Service Line Objective Providers will understand

More information

Under the Affordable Care Act (ACA), private insurers except for plans that have been

Under the Affordable Care Act (ACA), private insurers except for plans that have been Brought to you by the insurance professionals at HUB International Preventive Care Once an underused component of the health care world that benefits both employees health and employers health care spending,

More information

SCHEDULE OF BENEFITS PLAN M7

SCHEDULE OF BENEFITS PLAN M7 SCHEDULE OF BENEFITS PLAN M7 Effective September 1, 2016 All benefits, unless otherwise specified, are based on Usual, Customary and Reasonable (UCR) charges, or the network contracted amounts, and are

More information

Manage Your Health with Preventive Care

Manage Your Health with Preventive Care Manage Your Health with Preventive Care Preventive care is routine health care that focuses on maintaining your health and preventing disease. This can include annual physical examinations, screenings

More information

SCHEDULE OF BENEFITS PLAN H1

SCHEDULE OF BENEFITS PLAN H1 SCHEDULE OF BENEFITS PLAN H1 Effective June 1, 2018 This Plan is a High Deductible Health Plan (HDHP), designed to qualify for use with a Health Savings Account (HSA). All charges except charges for preventive

More information

Preventive health guidelines As of May 2018

Preventive health guidelines As of May 2018 Preventive health guidelines As of May 2018 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests and routine wellness exams to find disease

More information

Preventive Services Reference Guide for Members 2018

Preventive Services Reference Guide for Members 2018 Preventive Services Reference Guide for Members 2018 Together with Children s Community Health Plan (CCHP) covers many preventive services at no cost to you, including screening tests and immunizations

More information

Checking In on the Annual Check-up MICHAEL MIGNOLI, MD, FACP

Checking In on the Annual Check-up MICHAEL MIGNOLI, MD, FACP Checking In on the Annual Check-up MICHAEL MIGNOLI, MD, FACP Checking In on the Annual Check-up A BRIEF HISTORY OF THE ANNUAL PHYSICAL DEFINITIONS WHY BOTHER WITH AN ANNUAL PHYSICAL WHAT SHOULD YOU DO

More information

2019 Preventive Schedule Effective 1/1/2019

2019 Preventive Schedule Effective 1/1/2019 2019 Preventive Schedule Effective 1/1/2019 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

2017 Preventive Schedule

2017 Preventive Schedule 2017 Preventive Schedule PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The preventive guidelines

More information

2014 Preventative Care Guidelines. What are they? How are they used?

2014 Preventative Care Guidelines. What are they? How are they used? 2014 Preventative Care Guidelines What are they? How are they used? Review PACE Preventive Care Guidelines as related Longevity, Functional, and Comfort plans of care. Identify practical ways to incorporate

More information

Medicare Part B Preventive Services: Quick Reference Chart January 2009

Medicare Part B Preventive Services: Quick Reference Chart January 2009 Initial Preventive Physical Examination (IPPE) Also known as the Welcome To Medicare Visit (WMV) Medicare Part B Preventive Services: Quick Reference Chart Effective January 1, 2009 No specific diagnosis

More information

Preventive health guidelines As of May 2015

Preventive health guidelines As of May 2015 Preventive health guidelines As of May 2015 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

Indemnity PPO Medical Plan Preventive Care Guidelines

Indemnity PPO Medical Plan Preventive Care Guidelines Indemnity PPO Medical Plan Preventive Care Guidelines The Indemnity PPO Medical Plan offers 100% coverage for many routine preventive care services for you and your covered dependents when care is received

More information

Women s Preventive Health Guidelines

Women s Preventive Health Guidelines Women s Preventive Health Guidelines I. University Health Alliance (UHA) will reimburse for women s preventive health services when it meets the clinical preventive services guidelines below. II. Description

More information

UFCW LOCAL 1500 WELFARE FUND PREVENTIVE CARE SERVICE BENEFITS REVISED AS OF JANUARY 1, 2015

UFCW LOCAL 1500 WELFARE FUND PREVENTIVE CARE SERVICE BENEFITS REVISED AS OF JANUARY 1, 2015 UFCW LOCAL 1500 WELFARE FUND PREVENTIVE CARE SERVICE BENEFITS REVISED AS OF JANUARY 1, 2015 PREVENTIVE SERVICES Preventive Services Benefit Overview The UFCW Local 1500 Welfare Fund provides coverage for

More information

2019 Preventive Schedule Effective 1/1/2019

2019 Preventive Schedule Effective 1/1/2019 2019 Preventive Schedule Effective 1/1/2019 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

Preventive Service Benefits

Preventive Service Benefits Preventive Service Benefits This Plan provides coverage for certain Preventive Services as required by the Patient Protection and Affordable Care Act of 2010. Cover is provided on an in-network basis only,

More information

NEW YORK STATE TEAMSTERS COUNCIL HEALTH & HOSPITAL FUND APPENDIX A SCHEDULE OF BENEFITS SUPREME BENEFITS

NEW YORK STATE TEAMSTERS COUNCIL HEALTH & HOSPITAL FUND APPENDIX A SCHEDULE OF BENEFITS SUPREME BENEFITS BENEFIT GUIDE NEW YORK STATE TEAMSTERS COUNCIL HEALTH & HOSPITAL FUND APPENDIX A SCHEDULE OF SUPREME IN NETWORK FEATURES Primary Care Physician Not Required 2 Physician Referrals Not Required 2 Out of

More information

2016 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest.

2016 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest. 2016 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. We want to help you be your healthiest. That s why we recommend over 30 free preventive care services for kids,

More information

SCHEDULE OF BENEFITS PLAN C

SCHEDULE OF BENEFITS PLAN C SCHEDULE OF BENEFITS PLAN C Effective September 1, 2016 All benefits, unless otherwise specified, are based on Usual, Customary and Reasonable (UCR) charges, or the network contracted amounts, and are

More information

Services. Colorado RegionEALTH CARE REFORM UPDATE

Services. Colorado RegionEALTH CARE REFORM UPDATE Health Care Reform Preventive Hpreventive Services Services Colorado Region Colorado RegionEALTH CARE REFORM UPDATE Your guide to preventive services for the Preventive services coverage for over 65 years,

More information

ACA first-dollar coverage for preventive services

ACA first-dollar coverage for preventive services I N F O R M A T I O N U P D A T E September 2014 ACA first-dollar coverage for preventive services The Affordable Care Act (ACA) mandates that all non-grandfathered group and individual health plans must

More information

Preventive Care Coverage

Preventive Care Coverage STAYING WELL Preventive Care Coverage Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Wondering what preventive care your plan covers? Our

More information

Indemnity PPO Medical Plan Preventive Care Guidelines 2019

Indemnity PPO Medical Plan Preventive Care Guidelines 2019 Indemnity PPO Medical Plan Preventive Care Guidelines 2019 The District Council 16 Northern California Health and Welfare Trust Fund Medical Plan offers 100% coverage for many routine preventive care services

More information

Guidelines Description USPSTF HRSA CDC Benefit Description Types Ages

Guidelines Description USPSTF HRSA CDC Benefit Description Types Ages Guidelines Description USPSTF Evidence-based items or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force HRSA Evidence-informed exams,

More information

Are You Sure You Can Bill Preventive Services? Disclaimer

Are You Sure You Can Bill Preventive Services? Disclaimer Are You Sure You Can Bill Preventive Services? AAPC Regional Conference Chicago, Illinoisi October 2012 1 Disclaimer The information in this presentation was current at the time the presentation was complied

More information

To learn more about your plan, please see anthem.com/ca.

To learn more about your plan, please see anthem.com/ca. To learn more about your plan, please see anthem.com/ca. To learn more about vaccines, please see the Centers for Disease Control and Prevention (CDC) website: cdc.gov. Anthem Blue Cross is a health plan

More information

2018 Preventive Schedule

2018 Preventive Schedule 2018 Preventive Schedule Effective 1/1/2018 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

2018 Preventive Schedule Effective 1/1/2018

2018 Preventive Schedule Effective 1/1/2018 2018 Preventive Schedule Effective 1/1/2018 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

Preventive care services for commercial members

Preventive care services for commercial members Preventive care services for commercial members This schedule is a reference tool for planning your preventive care, and lists items/services covered under the Patient Protection and Affordable Care Act

More information

PREVENTIVE HEALTH GUIDELINES FOR PROVIDERS

PREVENTIVE HEALTH GUIDELINES FOR PROVIDERS PREVENTIVE HEALTH GUIDELINES FOR PROVIDERS Sanford Health Plan has adopted the preventive care benefits as outlined under The Patient Protection and Affordable Care Act. Members can refer to their Summary

More information

To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam

To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam 1/27/2015 To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam Fleur Sack, M.D., FAAFP Society of General Internal Medicine Cochrane review of 182,000 people followed for 9 years : the

More information

Preventive Care Coverage

Preventive Care Coverage STAYING WELL Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association Preventive Care Coverage Wondering what preventive

More information

Preventive Care Coverage

Preventive Care Coverage Preventive Care Coverage Benefits designed to protect your health BridgeSpanHealth.com Review Coverage» To find out if you re eligible for preventive coverage, call the Member Services number on the back

More information

Schedule of Benefits

Schedule of Benefits 3 Patient Protection and Affordable Care Act ( PPACA ) Compliance: The Plan will at all times be in compliance with PPACA rules and regulations. Notes regarding the Plan This Plan provides coverage for

More information

2019 Preventive Schedule Effective 1/1/2019

2019 Preventive Schedule Effective 1/1/2019 2019 Preventive Schedule Effective 1/1/2019 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky (includes kynect)

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky (includes kynect) Summary of Cancer Prevention and Screening Benefits of the Talk with patients about ü Potential benefits, harms, and uncertainties of cancer screening ü Identify family history ü Cancer prevention, early

More information

2019 Preventive Schedule

2019 Preventive Schedule State System of Higher Education 2019 Preventive Schedule Effective 1/1/2019 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early,

More information

Wellness Preventive Health Guide

Wellness Preventive Health Guide Wellness Preventive Health Guide Protect Your Health with Good Preventive Care Plan Now for Better Health One of the best ways to maintain good health and lower the risk of future health concerns for you

More information

Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer

Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Healthy Habits and Cancer Screening Rev 10.20.15 Page

More information

2018 Preventive Schedule Effective 1/1/2018

2018 Preventive Schedule Effective 1/1/2018 2018 Preventive Schedule Effective 1/1/2018 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Talk with patients about ü Cancer Prevention & Early Detection ü Benefits, harms

More information

PREVENTIVE HEALTH GUIDELINES

PREVENTIVE HEALTH GUIDELINES PREVENTIVE HEALTH GUIDELINES As of May 2016 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

Preventive health guidelines

Preventive health guidelines Preventive health guidelines As of May 2017 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

2017 Preventive Schedule

2017 Preventive Schedule 2017 Preventive Schedule PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The preventive guidelines

More information

Preventive health guidelines As of May 2017

Preventive health guidelines As of May 2017 Preventive health guidelines As of May 2017 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

Blue represents coding updates. G0389 with diagnosis V81.2, V15.82, or with diagnosis V79.1, or

Blue represents coding updates. G0389 with diagnosis V81.2, V15.82, or with diagnosis V79.1, or An Independent Licensee of the Blue Cross and Blue Shield Association Preventive Care Services The following is a list of preventive services (HCP rider) along with the diagnoses and procedure codes that

More information

2018 Preventive Schedule

2018 Preventive Schedule 2018 Preventive Schedule Effective 1/1/2018 PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The

More information

2018 Preventive Schedule

2018 Preventive Schedule 2018 Preventive Schedule Medicare-Covered Services PLAN YOUR CARE: KNOW WHAT YOU NEED AND WHEN TO GET IT Preventive or routine care helps us stay well or finds problems early, when they are easier to treat.

More information

Preventive health guidelines

Preventive health guidelines To learn more about your plan, please see www.anthem.com/ca/medi-cal Preventive health guidelines As of May 2016 To learn more about vaccines, please see the Centers for Disease Control and Prevention

More information

The Guidelines Guide: Routine Adult Screening Created March 2009 by Alana Benjamin, MD Last updated: June 29 th, 2010

The Guidelines Guide: Routine Adult Screening Created March 2009 by Alana Benjamin, MD Last updated: June 29 th, 2010 The Guidelines Guide: Routine Adult Screening Created March 2009 by Alana Benjamin, MD Last updated: June 29 th, 2010 Table of Contents Topic Page Introduction 2 Abbreviations 2 USPSTF Grades of Recommendations

More information

Preventive health guidelines As of May 2014

Preventive health guidelines As of May 2014 To learn more about your plan, please see anthem.com/ca. To learn more about vaccines, please see the Centers for Disease Control and Prevention (CDC) website: cdc.gov. Preventive health guidelines As

More information

An Apple a Day. Prevention as A Treatment for MS CMSC Mary Kay Fink, ACNS-BC, MSN, MSCN. The MS Center of Saint Louis

An Apple a Day. Prevention as A Treatment for MS CMSC Mary Kay Fink, ACNS-BC, MSN, MSCN. The MS Center of Saint Louis An Apple a Day Prevention as A Treatment for MS CMSC 2015 Mary Kay Fink, ACNS-BC, MSN, MSCN The MS Center of Saint Louis Preventive Healthcare Preventive healthcare (alternately preventive medicine or

More information