CMS sponsored a conference call last week to make sure that Part B providers are aware of new services payable by Medicare. These services were in effect late in 2011, but most providers are not aware of their existence. Is your practice using these new Medicare reimbursement codes?
Screening & Counseling for Alcohol Misuse
Why does CMS consider alcohol misuse screening and counseling important for Medicare patients?
According to the USPSTF (2004), alcohol misuse includes risky/hazardous and harmful drinking which place individuals at risk for future problems; and in the general adult population, risky or hazardous drinking is defined as >7 drinks per week or >3 drinks per occasion for women, and >14 drinks per week or >4 drinks per occasion for men. Harmful drinking describes those persons currently experiencing physical, social or psychological harm from alcohol use, but who do not meet criteria for dependence.
Which providers can provide alcohol misuse screening and counseling for Medicare patients?
On July 19th, the Centers for Medicare & Medicaid Services (CMS) proposed to add alcohol screening and behavioral counseling, and screening for depression, to the comprehensive package of preventive services now covered by Medicare. These proposed national coverage determinations (NCDs) are issued under authority granted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which allows CMS to add coverage of new preventive benefits that are recommended by the U.S. Preventive Services Task Force and are appropriate for Medicare beneficiaries.
Today’s CMS call reviewed the guidelines for the IPPE (Initial Preventive Physical Exam) and the AWV (Annual Wellness Visit), what they include and how to code for them.
What is the IPPE (also called the “Welcome to Medicare Visit”)?
The IPPE is a one-time visit, covered within 12 months after the effective date of Part B coverage and including:
Review of medical and social history.
Review of risk factors for depression.
Review of functional ability and level of safety.
Measurement of height, weight, body mass index, blood pressure, visual acuity, and other factors deemed appropriate.
Discussion of end-of-life planning, if agreed upon by the patient.
Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (a/k/a EKG, ECG).
Note that although the IPPE has the word “exam” in it, there is NO physical exam associated with it. Most practices attempt to call it the Welcome to Medicare Visit and try never to use the word “exam” in association with it.
Who can provide the IPPE?
Physician (doctor of medicine or osteopathy)
Qualified non-physician practitioner including nurse practitioner physician assistant or Clinical nurse specialist