What Is Covered in Medicare 2011–Changes and New Benefits
If you have not seen the recent news, Office Ally is now certified for our 24/7 electronic medical records system. 24/7 users will be able to demonstrate meaningful use. This is going to be very important in the upcoming years for sure.
Today we thought we would feature some information from one of the blogs we like to read.
“Manage My Practice” published some information about changes that will be coming next year. You can find the link to Pat Whaley’s blog under our links section too.
We will include a few of the highlights from her update and for more information you can visit here blog entry and you might find a lot of other useful information there too. One other bit of good news for Family Practice physicians is the 99213 code compensation will be going up too and if you work in a family practice you are probably more than well aware that this probably covers about 70-85% of the coding for patient visits.
One of the big changes and benefits has to do with the allowance of an Annual Wellness Visit that includes a thorough review of your health at no charge. This is the gateway to getting started and when you read through the listing of other services, it makes sense as other 
screenings, such as mammograms and diabetes screenings are included for those who are considered “high risk”.
One other item to keep in mind is thinking about starting a PHR (personal health record) as a patient or recommending one to your patients if you are a physician and Office Ally can help with Patient Ally, our “FREE” personal health record.
You can visit the Patient Ally Website and find out more information and get started.
You can find the full article at Pat Whaley’s website
Medicare Benefits Beginning January 1, 2011
- Medicare covers a one-time preventive physical exam within the first twelve months of
having Part B. The exam will include a thorough review of health, education and counseling about the preventive services covered by Medicare and referrals for other care if needed. No Part B deductible and effective January 1, 2011 you pay nothing if the doctor accepts assignment.
- Abdominal Aortic Aneurysm Screening – People at risk for abdominal aortic aneurysms may get a referral for a one-time screening ultrasound at their “Welcome to Medicare” physical exam. Effective January 1, 2011 no deductible and no copayment.
- New Annual Wellness Visit – Effective January 1, 2011 Medicare will cover an Annual Wellness Visit that includes a thorough review of health, education and counseling about the preventive services covered by Medicare and referrals for other care if you need it. It is available every 12 months (after first 12 months of Part B coverage) but not within 12 months of receiving either a “Welcome to Medicare” physical exam or another Annual Wellness Visit. No Part B deductible – Medicare pays 100% of the approved amount.
- Cardiovascular Screening Blood Tests - Medicare covers cardiovascular screening tests that check cholesterol and other blood fat (lipid) levels every 5 years. Includes:
- Total Cholesterol Test
- Cholesterol Test for High Density Lipoproteins; and
- Triglycerides Test
- No Part B deductible – Medicare pays 100% of approved amount.
- Diabetes Screening Tests - Anyone enrolled in Medicare identified as “high risk” for diabetes will be able to receive screening tests to detect diabetes early. Covers up to two screenings each year. Includes:
- Fasting plasma glucose test
- Post-glucose challenge test
- No Part B deductible – Medicare pays 100% of approved amount
- Glaucoma Screening – Must be done or supervised by an eye doctor (optometrist or ophthalmologist). Covered annually for:
- Those with diabetes
- Those with a family history of glaucoma
- African-Americans age 50 and older
- Hispanic-Americans age 65 and older
- Other high risk individuals
- Medicare pays 80% of the approved amount after you meet the yearly Part B deductible.
- Bone Mass Measurement - For those enrolled in Medicare at high risk for losing bone mass. Effective January 1, 2011 no Part B deductible – Medicare pays 100% of approved amount.
- Screening Mammography (including new digital technologies) – For women age 40 and older enrolled in Medicare:
- Covered annually
- No Part B deductible – Medicare pays 100% of approved amount beginning January 1, 2011.
- Screening Pap Test & Pelvic Examination (Includes clinical breast examination) – For all women enrolled in Medicare:
- Covered once every two years for most
- Covered annually for women at high risk
- No Part B deductible – Medicare pays 100% of approved amount for Pap test and effective January 1, 2011 pays 100% of approved amount for pelvic and breast exam.
- Colorectal Cancer Screening – For all those enrolled in Medicare age 50 and older:
- Fecal-Occult blood test covered annually – No Part B deductible & Medicare pays 100% of approved amount. No Part B deductible and copayment for Doctor’s office visit starting January 1, 2011.
- Flexible sigmoidoscopy once every four years or 10 years after a previous screening colonoscopy– No Part B deductible or copayment starting January 1, 2011.
- Barium enema can be substituted for sigmoidoscopy or colonoscopy – No Part B deductible – Medicare pays 80% of the approved amount. You will pay a higher coinsurance if the test is done in a hospital outpatient department.
- Colonoscopy for any age enrolled in Medicare
- Average risk – Once every ten years, but not within four years after a screening flexible sigmoidoscopy
- High-risk – Once every two years
- No Part B deductible and effective January 1, 2011 Medicare pays 100%.
- Prostate Cancer Screening Tests -For all men enrolled in Medicare age 50 and older:
- Covered annually
- Digital rectal exam – Medicare pays 80% of the approved amount after the deductible
- Prostate Specific Antigen (PSA) test
- No Part B deductible – Medicare pays 100% of approved amount.
- Diabetes Monitoring and Education – Covers Type I and Type II diabetics enrolled in Medicare who must monitor blood sugar (Not paid for those in a nursing home) Covered services:
- Glucose-monitoring devices, lancets & strips
- Education & training to help control diabetes
- Foot care once every 6 months for those with peripheral neuropathy
- Medicare pays 80% of the approved amount after you meet the yearly Part B deductible.
- Medical Nutritional Therapy – Covered for those with diabetes or kidney disease. Includes diagnosis of special nutrition needs, therapy and counseling services to help you manage your disease. Medicare pays 80% of the approved amount after you meet the yearly Part B deductible.
- Smoking Cessation Services – Medicare will cover up to 8 counseling sessions per year for individuals who have an illness caused or complicated by tobacco use or you take medication affected by tobacco use. Medicare pays 80% of the approved amount after you meet the yearly Part B deductible.
- Flu Vaccination Annually (Medicare pays once per season. You do not have to wait 365 days since your last one.) No Part B deductible – you pay nothing if your doctor accepts assignment. My post on billing for the flu shot is here.
- H1N1 Flu Vaccine Medicare covers the administration of the H1N1 flu shot. You cannot be charged for the vaccine. No Part B deductible or co-insurance.
- Pneumococcal Pneumonia Vaccination- Once per lifetime for all enrolled in Medicare. (A doctor may order additional ones for those with certain health problems.) No Part B deductible – Medicare pays 100% of approved amount.
- Hepatitis B Shots – Covered for those who are at medium or high risk. Effective January 1, 2011, there will be no Part B deductible and Medicare pays 100%.
began as a “free clearinghouse” for providers in the year 2000 and we continue to expand and create solutions to help the providers and hospitals. When Office Ally began operations, we were the first company to offer free services where others charge providers for this service. To keep our services free, all we ask is that 50% of the claims submitted be commercial, in other words going to insurance companies, and then the rest, your Medicare and Medicaid get to ride along for free with electronic submissions. 
without having to do the same in house.
