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2014 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY

West Virginia Geriatrics Society

“Medicare’s Preventive Services and the New Annual Wellness Visit”

Todd H. Goldberg MD CMD FACPAssoc. Prof. / Chief of Geriatrics

WVU Health Sciences Center/CAMCCharleston, WV 25304

Learning Objectives• Upon completion of this session the

participant should be able to:

• Understand the sources of preventive medicine recommendations and Medicare laws and coverage guidelines for same

• Know and follow USPSTF and Medicare guidelines for preventive services in older adults

• Perform Welcome to Medicare and Annual Wellness Visits and correctly document, code and bill for these.

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Sources of guidelines

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Parts of Medicare

Part A – Hospital Insurance

Part B – Supplemental Medical Insurance (Physicians/Outpatient)

HMO’s/Med. Advantage (Part C)

Drugs (Part D)

Prevention & Screening Benefits under Medicare & USPSTF

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Medicare Law – Preventive Services

TITLE 42 - THE PUBLIC HEALTH AND WELFARECHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVIII - HEALTH INSURANCE FOR AGED AND DISABLEDPart E - Miscellaneous Provisions

§ 1395y. Exclusions from coverage

• (a) Items or services specifically excluded• Notwithstanding any other provision of this subchapter, ->> no payment may be made under part A or part• B of this subchapter for any expenses incurred for items or services—• (1) (A) which, except for items and services described in a succeeding subparagraph, are not• reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the• functioning of a malformed body member, -<<• (B) in the case of items and services described in section 1395x (s)(10) of this title, which• are not reasonable and necessary for the prevention of illness,• (F) in the case of screening mammography, which is performed more frequently than is• covered under section 1395m (c)(2) of this title or which is not conducted by a facility• described in section 1395m (c)(1)(B) of this title, in the case of screening pap smear and• screening pelvic exam, which is performed more frequently than is provided under section• 1395x (nn) of this title, and, in the case of screening for glaucoma, which is performed more• frequently than is provided under section 1395x (uu) of this title,• (G) in the case of prostate cancer screening tests (as defined in section 1395x (oo) of this• title), which are performed more frequently than is covered under such section,• (H) in the case of colorectal cancer screening tests, which are performed more frequently• than is covered under section 1395m (d) of this title,• (K) in the case of an initial preventive physical examination, which is performed not later• than 6 months after the date the individual’s first coverage period begins under part B of this• subchapter,• (L) in the case of cardiovascular screening blood tests (as defined in section 1395x (xx)(1) of• this title), which are performed more frequently than is covered under section 1395x (xx)(2)• of this title, and• (M) in the case of a diabetes screening test (as defined in section 1395x (yy)(1) of this title),• which is performed more frequently than is covered under section 1395x (yy)(3) of this title;

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ACA

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Prevention & Screening in the elderly under Medicare

Once during Welcome to Medicare in male smokers only!

Once during first 12 months of Medicare only! Order AAA.

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Screening for Alzheimer’s/Dementia

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Annals of Internal Medicine June 2014

AWV Cognitive Screening

Remember 3 Words (Hat, Car, Tree)

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IPPE

Billing Codes and Copays for IPPE

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AWV Template

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AWV - Social and Family History

PMH, Allergies, Meds, Problem List

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Problem List/Other Providers

Depression, Function and Cognitive Evaluation

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Vision Screen & EKG

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Advice/Referrals/Handouts, Advance Directives

AWV - Preventive Services (PPPS)

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AWV PPSP Cont’d

AWV Prevention Concl.

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USPSTF & Obamacare

USPSTF II

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USPSTF III

CODING AND REIMBURSEMENT

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ONE LAST THING