Part B Insider (Multispecialty) Coding Alert

Published on Tue Jul 27, 2004 PDF

6 tips to pave the way for initial Medicare physical exam

Starting next year, Medicare will offer a new "welcome to Medicare" physical exam for patients joining the program. This means an opportunity to build your practice and a chance to safeguard your patients'wellness.

Your practice could reap goodwill and reconnect with patients by reminding them of this new benefit. "It's just a great opportunity for physicians to build their practices," says consultant Jack Valancy in Cleveland Heights, OH.

"There's nothing wrong with advertising," says consultant W. Robert Cooper with W. Robert CooperAssociates in Peoria, IL. "Primary care doctors aren't usually involved in a typical reminder concept," but OB/Gyn physicians are accustomed to reminding patients of pap smears and breast checkups. This could be a chance for other physicians to get better at issuing reminders.

The exam won't be covered for existing beneficiaries, but it will provide a baseline for patients who are joining Medicare next year or after. The exam should include measurement of height, weight and blood pressure, electrocardiogram, screening for chronic conditions, counseling on health risks and referrals to other preventive services.

Experts offer the following tips for taking advantage of this service:

Tip: Run reports based on birth date. Your front desk collects demographic information, including birth date. Periodically, you should run a report listing every patient who was born in 1940, so you can remind those patients that they're joining Medicare and are eligible for this initial physical exam, says Valancy.

Tip: Your practice also can set up a system at the front desk to notify patients of the benefit when they present their Medicare cards for the first time, notes Valancy. The only problem with this system is that patients may take months to come in to the office after they join Medicare, even if the program starts notifying people of the initial physical.

Tip: Create a unique identifier in your system for the exam. Since the "welcome to Medicare" exam will be a one-time benefit, you want to avoid billing for it twice.

So it's important to add a special marker for that benefit in your system, says Valancy.

Tip: For new patients, ask. If the if the patient isn't just new to Medicare but new to your practice as well, make sure they haven't already received this "welcome to Medicare" exam at their previous physician's office, Valancy recommends.

Tip: Promote the new benefit. Physicians can visit senior centers and explain the Medicare rules, and mention that new Medicare patients will be entitled to this initial exam starting next year, Valancy recommends.

Tip: If your practice prints any kind of brochure, it should mention this initial exam, says Martin Blume, an internist and consultant with Eagle Medical Management in Scottsdale, AZ. If you have bulletin boards in your office, they should mention the new benefit. And when you send out statements to patients, they should plug the exam as well. Even if the patients receiving the statements are the wrong age, they may have friends or relatives who are becoming eligible.