Beginning January 1, 2011, your clients will get an Annual Wellness visit, covered by Medicare every 12 months, starting a year (12 months) after they get their initial “Welcome to Medicare” physical exam. And if your client never had a Welcome to Medicare exam, that’s ok; now they can get their free Annual Wellness visit each year. This is the first time Medicare will cover an annual exam, and there is no cost-sharing (coinsurance or deductible) for this service.
During the visit, your client and health care provider will develop a personalized prevention plan, building off of the initial exam. Note, there are slight distinctions between the first wellness visit and subsequent such visits.
The initial Annual Wellness visit includes:
The Centers for Medicare and Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas. The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.
The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit. This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or "Welcome to Medicare Visit") with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient's individual risk factors.
According to the Centers for Medicare & Medicaid Services (CMS), the new law establishes 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates from June 1 through Nov. 30, 2010. Medicare contractors have been instructed by CMS to discontinue processing claims at the negative update rates and to temporarily hold all claims after June 1 until the new rates are tested. CMS says it expects processing will resume by July 1.
In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21.3% reduction in Medicare reimbursement to physicians and other health providers.
A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.
The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.
Because Medicare claims are not paid any sooner than 14 days after receipt, technically Congress has until June 13th to adopt legislation avoiding the 21.3% cut. CMS is using various communication tools to make Physicians aware of this situation.