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MEDICARE

HOW WE DO IT

Medicare

Why medicare preventative services?

<35%

Patients are provided an individual preventative service

<20%

Patients receiving an Annual Wellness Visit

Significant under utilization

Utilization encouraged by Medicare

Additional preventative services being added annually

Move toward Value Based reimbursement

Provider Wellness Myths

Original Medicare’s AWV includes a physical

Medicare Part B does not cover routine physical examinations.

Medicare Advantage Plans can do a Physical as Part of the AWV

Many MA plans cover both the physical and the AWV

Providers typically capture Most of the Components of the AWV

Our audits indicate that most providers miss significant components such as a written care plan with educational materials

Providers Assure that patients with 2 or more Chronic Conditions are enrolled in CCM

Medicare believes the AWV encourages patients to enroll in CCM, which assures the written care plans are followed

Providers appropriately Maximize Revenue as part of the AWV

There is a group of appropriate billable services that can be offered at the same time as the AWV

Overview of Medicare

Medicare has drastically changed the way they are reimbursing physicians. Costs are increasing to provide care and the landscape is ever changing as it relates to data capture and reporting requirements. Preventive care is becoming the focus of payers and is where reimbursement dollars are being allocated.