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Why Medicare Does Not Cover the Annual Physical Exam

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Lucy Lamboley

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Why Medicare Does Not Cover the Annual Physical Exam

A Kaiser Health News (KHN) article tells the story of Medicare beneficiary Beverly Dunn. She scheduled her annual physical exam, believing that Medicare would cover the checkup. Then Dunn received the bill and quickly learned the shocking piece of information many patients discover: Medicare does not cover annual physical exams.

Osteoarthritis & Rheumatoid Arthritis: Role of Remote Care Management

Arthritis is probably one of the most bothersome health issues patients face. Classified as both degenerative and chronic, arthritis not only produces pain, but it can also increase symptoms of anxiety and depression, impact independence, contribute to sleep problems, and lead to a host of other chronic health issues due to neglectful self-management of the disorder. Fortunately, those with the two most common types of arthritis — osteoarthritis and rheumatoid arthritis — are eligible for participation in both chronic care management (CCM) and remote patient monitoring (RPM) services. These services can be quality-of-life difference-makers for those with osteoarthritis and rheumatoid arthritis.  With the wraparound care provided via the CCM and RPM care models, arthritis patients will receive the connected support they need to better manage symptoms and slow disease progression. Specifically, participation in these types of programs will help patients improve their self-management and coping skills. This can lead to decreased pain and physical harm, helping arthritis patients maintain — or even increase — activity levels and better preserve their independent lifestyle. 

New Medicare Chronic Care Service: Chronic Pain Management (CPM)

There were a number of significant changes affecting the delivery and billing of remote care management in the 2023 Medicare Physician Fee Schedule (PFS) final rule, as we covered in this webinar. One of them was the Centers for Medicare & Medicaid Services (CMS) finalizing the coverage for chronic pain management and treatment services (CPM) — new services that were introduced in the 2023 Medicare PFS proposed rule.  

In Defense of the Medicare Annual Wellness Visit

Medicare's annual wellness visit (AWV) has had a rocky ride since its introduction in 2010 and started in 2011 as part of the Affordable Care Act. As with many big healthcare changes, the new service was met with resistance and steeped in confusion, leading to terribly slow uptake and obstacles that still unjustly plague the service more than a decade later. When Medicare beneficiaries do not receive their AWV, this is not only a disservice to these patients, but practices and the healthcare system as a whole lose out on important and impactful benefits. 

Improve Preventive Care With a Better Cardiovascular Risk Assessment

As a practitioner, you understand how beneficial a cardiovascular risk assessment is for your patients. While assessing and treating your patient's cardiac risk factors is beneficial, it can eat up one of your most valuable resources: time. Finding time-saving tools that you can trust and rely on forcompliance and accuracy is almost as important as performing the risk assessment itself.  

Chronic Care Management: Services Your Patients Need

I'm sure we're all aware of the American way of life — the one where many of us actively partake in regular bad habits like smoking, drinking, consuming unhealthy foods, and look past our largely inactive lifestyles where only about 23% of us actually get the recommended 150 minutes of aerobic and muscle-strengthening exercise per week. While the impact of these not-so-great choices may be out of sight and therefore out of mind for younger people, the reality is that the delayed effects are just a ticking time-bomb of chronic disease waiting to happen.

Social Determinants of Health: Chronic Care Management Program Role

Part two in a two-part series (access part one) Imagine calling your chronic care case management patient for their weekly check-in only to find out that they haven't taken their blood pressure medication in four days. While the direct effect of the missed medication is worrisome, even more concerning might be the reason why the patient is skipping doses in the first place. Within chronic care management programs, it's not uncommon to run into these types of patient problems, and these situations probably arise more often than we like, or we'd like to admit. Often, the cause or a significant contributing factor to patient non-adherence with a chronic care management program is social determinants of health (SDoH).

Overcoming Social Determinants With Chronic Care Management Solutions

Part one in a two-part series It's been well-documented that social determinants impact the health and wellness of patients in numerous ways, but how do we more effectively address those issues that impact patients negatively? One path provider organizations are increasingly taking to help them overcome social determinants of health (SDoH) challenges is through the addition of chronic care management solutions.

AAFP Survey Suggests Significant Annual Wellness Visit Non-Compliance

The results of a survey suggest that upwards of about 85% of Medicare annual wellness visits (AWV) may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS). The results should motivate providers to verify that the tools they are using during AWVs for Medicare patients effectively prompts them to ensure no required components are missed. If a required element is missed, the AWV can be considered non-compliant by an auditor, potentially leading to clawbacks and other penalties. In egregious and willful cases, a non-compliant practice could even face exclusion from Medicare or criminal liability.

Benefits of Chronic Care Management for Providers and Patients 

There are numerous benefits of chronic care management (CCM) that help patients, providers, and payers alike. Since chronic disease is a runaway freight train here in the United States the chronic care management model is functioning somewhat as a proverbial emergency break, slowing down the speed in which chronic disease is impacting our economy and our patients' health and longevity.

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