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Welcome to Medicare Visit
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) expanded Medicare's menu of preventive benefits by covering an initial preventive physical examination. This benefit, also referred to as the "Welcome to Medicare" visit, is an excellent way for new Medicare beneficiaries to get up-to-date on important screenings and vaccinations, as well as to talk with their health care provider about their medical history and how to stay healthy. The Welcome to Medicare visit enables the health care provider to comprehensively review his or her patient's health, to identify risk factors that may be associated with various diseases, and to detect diseases early when outcomes are best. The health care provider is also able to educate his or her patient about the Medicare covered services they need in order to prevent, detect, and manage disease, to counsel them on identified risk factors and possible lifestyle changes that could have a positive impact on their health, and to make referrals or follow-up appointments for necessary care. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made several important changes to this benefit. Beneficiaries enrolled in Medicare Part B with effective dates that begin on or after January 1, 2009, will have one year from their Part B enrollment date to take advantage of this one-time visit. Previously, Medicare beneficiaries only had 6 months from their Part B enrollment date to have this important service. In addition, several components of the Welcome to Medicare visit have changed. The Welcome to Medicare visit is a comprehensive examination consisting of the following 7 components:
1. A review of an individual's medical and social history with attention to modifiable risk factors
2. A review of an individual's potential risk factors for depression
3. A review of the individual's functional ability and level of safety
4. A physical examination to include an individual's height, weight, blood pressure, visual acuity, and measurement of body mass index (a new requirement effective Jan. 1, 2009)
5. End-of-life planning (a new requirement effective Jan. 1, 2009)
6. Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components
7. Education, counseling, and referral, including a brief written plan such as a checklist for obtaining the appropriate screening and/or other Medicare Part B preventive services *Performance of an electrocardiogram (EKG) and interpretation of the EKG is no longer required as part of this service. Note: The reimbursement for this benefit does not include any clinical laboratory tests. The physician, qualified non physician practitioner, or hospital may also provide and bill separately for the screening and other preventive services that are currently covered and paid for by Medicare Part B. Also, as of January 1, 2007, Medicare will pay for a one-time ultrasound screening for Abdominal Aortic Aneurysm (AAA) for beneficiaries who are at risk. Eligible beneficiaries must receive a referral for the screening as a result of their Welcome to Medicare physical exam. What the Beneficiary Pays Coverage of the Welcome to Medicare visit is provided as a Medicare Part B benefit. For dates of service on or after January 1, 2009, the annual Part B deductible is waived if the Welcome to Medicare visit does not include the electrocardiogram, which is no longer a required part of the visit as of January 1, 2009. However, if the EKG is included as part of the Welcome to Medicare visit (performed with or without interpretation and report, or just its interpretation and report), the deductible will apply. The coinsurance or co-payment still applies regardless of the type of Welcome to Medicare visit the beneficiary receives. Other Helpful Information
Various organizations have developed tools to help support providers in the delivery of this important benefit, and to prepare beneficiaries for this visit. Links to these resources are provided below and on the other pages of the Welcome to Medicare section.
Page Last Modified: 01/13/2009 2:56:06 PM
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