Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 06, 2005 PDF

3 tips guard against glitches when you provide this new service

Medicare's new initial exam benefit is potentially vexing, but also a great chance to build relationships with your patients.

Because Medicare patients only receive coverage for this benefit once in their lifetime - and only within the first six months after joining Medicare - you should aim to provide the service early, but not often. Providers already grappling with the new exam offer the following tips for coping with the challenge of ensuring coverage for this service:

1. Ask patients to sign an advance beneficiary notice (ABN). "We have a lot of snowbirds," says Joyce Jones, office manager with Memorial Health Clinic in Aurora, NE, referring to patients who travel south for the winter. "We don't really have a way to track whether they [already had the exam] somewhere else." So Memorial asks all patients who have the exam to sign an ABN and agree to pay out-of-pocket for the service if Medicare denies the claim.

2.  Add a note to patients' files when they've had the exam already. Memorial has set up a system to track whether patients have had the "Welcome" exam at their clinic, Jones notes.

3. Don't ask patients about their exam status just once. Bayshore Family Practice in Pasadena, TX, questions patients about the exams twice, according to business manager Donna Jones.

When patients make their appointments, the receptionist asks if they've just enrolled in Medicare - and when that enrollment became effective. Then when the patients come in for their visits, the doctor asks the same questions. This is "one last effort to make sure the patients are able to get [coverage for] everything they have come in for," says Jones at Bayshore.
 
Vigilance Now Will Prevent Trouble Later

The most important thing is to avoid having "any surprises down the road," says Jones at Bayshore. You don't want to find out later that a patient didn't receive the exam during the six-month window, or that a patient received the exam twice, she adds.

Remember: Patients who enter a Medicare managed care plan and then return to regular Medicare aren't eligible for the exam, Jones at Bayshore notes.