Leveraging Wellness Visit with Medicare: Improving Income and Patient Outcomes
|
|
- Marylou Stokes
- 5 years ago
- Views:
Transcription
1 Leveraging Wellness Visit with Medicare: Improving Income and Patient Outcomes
2 Overview Why Medicare Wellness Exams What are the Medicare Wellness Exams Annual Wellness Exam Components What is covered by the Medicare for wellness How to code for the Medicare Wellness Exams
3 Why Wellness Exams Enhanced reimbursement ($172) Performed by mid-level Improve patient outcomes Collect PQRS and MU data Prepare for CMS Value Modifier 3
4 Who Can Perform AWV Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a: Physician (doctor of medicine or osteopathy) Physician assistant Nurse practitioner Clinical nurse specialist Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy) 4
5 What are Wellness exams In the words of CMS: CMS is committed to promoting the appropriate use of Medicare preventive services. Medicare now covers a broad range of services to prevent disease, detect disease early when it is most treatable and curable, and manage disease so that complications can be avoided CMS recognizes the crucial role that health care providers play in providing and educating Medicare beneficiaries about potentially life-saving preventive and services and screenings.
6 What is Covered Preventive services Initial Preventive Physical Exam (IPPE) AKA Welcome to Medicare Preventive Physical Annual Wellness Visit (AWV) Screenings Vaccinations Behavior therapy and counseling
7 Annual Wellness Visit (AWV) Initial visit vs Subsequent visit Not within 12 months of starting benefits or last IPPE/AWV Copay/Coinsurance: No Elements History: The patient s past medical, surgical and family history, including medications and supplements, and current providers. Assessment: The patient s height, BMI (initial AWV only), weight, blood pressure and other measures deemed appropriate based on the patient s family and medical history. Cognitive function: Assessment and detection of any cognitive function impairment through observation and/or screening. Screening schedule: A schedule of recommended, age-appropriate screenings for the patient to receive in the next five to 10 years based on recommendations from the U.S. Preventive Services Task Force and the patient s health status and screening history. Risk factors: A list of the patient s current risk factors for conditions, including mental health, along with treatment options, risks and benefits. Personalized health advice: Referrals to programs as needed (i.e. tobacco cessation, fall prevention, nutrition, weight loss, etc.) NOT A PHYSICAL EXAM!
8 IPPE and AWV Clarifications Preventive wellness visits are not annual physical exams Can be performed by a qualified health professional Although specific labs/tests are not included in the IPPE or AWV, tests may be ordered resulting from the exam One-time AAA screening only covered if ordered during an IPPE, not an AWV
9 IPPE and AWV Clarifications A diagnosis code is required, but not a specific one Confirm an IPPE or AWV hasn t been performed within the past 12 months Separate E/M and medically necessary services can be billed at the same time as the IPPE or AWV with modifier -25 NOT A PHYSICAL
10 Screening EKG IPPE only Copay/Coinsurance: Yes Ultrasound for AAA IPPE only and if meets certain criteria Cardiovascular Screening - Lipids Every 5 years
11 Screening Diabetes fasting/non-fasting glucose/gtt Non-diabetics meeting criteria 1-2 times per year depending on previous results Glaucoma Annually if criteria met Copay/Coinsurance: Yes Bone Mass Measurement Every 2 years if criteria met (sooner if medically necessary)
12 Screening Colorectal Cancer several options Age > 50 yo, timing varies depending on test and risk factors Prostate DRE/PSA Annually beginning the day after 50 th birthday Copay/Coinsurance: PSA No/ DRE Yes Lung Cancer Low dose CT Scan Annually for those eligible Depression Annually
13 Screening Pap Tests Annually if certain criteria met, otherwise every 2 years Pelvic Exams Annually if certain criteria met, otherwise every 2 years Mammography Female yo - one baseline, >40 yo annually
14 Screening Alcohol Misuse Annual screening Sexually Transmitted Infections Women GC/Chlamydia/Syphilis/Hepatitis B Annually for increased risk, 1-3 times per pregnancy (dz dependant) Men Syphilis only Annually for increased risk HIV Annually for high risk patients, 3 times per pregnancy
15 Vaccinations Seasonal Influenza Once per season, more if medically necessary Pneumonia Once in a lifetime, more if medically necessary and > 5 yrs since last Hepatitis B Scheduled dosing if at high or intermediate risk
16 Vaccinations Those NOT covered under Medicare Part B Zoster Vaccine TDaP Though covered under Medicare Part D (medications)
17 Counseling Diabetes Self-Management Training Individual or group; 10 hrs 1 st year, 2 hrs subsequent years Copay/Coinsurance: Yes Medical Nutrition Therapy Individual or group; 3 hrs 1 st year, 2 hrs subsequent years Diabetes, renal disease/kidney transplant within 3 yrs Intensive Behavioral Therapy for CV Disease Individual; Annually
18 Counseling Intensive Behavioral Therapy for Obesity Individual; Multiple visits over 6-12 months Tobacco Use Two cessation attempts per year; up to 4 sessions per attempt Alcohol Misuse (Not Dependence) Individual; Four visits per year Sexually Transmitted Infection Prevention Individual; Twice per year
19 How to code Initial Annual Wellness Visit($172) G0438 Any ICD9 Subsequent Annual Wellness Visit ($111) G0439 Any ICD9 Coding for additional E&M Modifier -25
20 How To Code
21 How To Code
22 How To Code
23 How To Code
24 How To Code
25 How To Code
26 How To Code
27 Resources Info Info/Downloads/MPS_QuickReferenceChart_1.pdf Learning-Network- MLN/MLNProducts/downloads/AWV_chart_ICN p df nfo/downloads/healthriskassessmentscdcfinal.pdf Learning-Network- MLN/MLNProducts/PreventiveServices.html
28
TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting
TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting CONFUSED ABOUT MEDICARE PREVENTATIVE VISITS? SO ARE YOUR PATIENTS! Congress legislated coverage for two preventive visits for Medicare
More informationCoding and Billing for Lifestyle Medicine
Coding and Billing for Lifestyle Medicine Presented to Tools for Healthy Change June 21, 2014 Agenda Understanding Documentation Guidelines and key components of E/M Services History, Exam, Medical Decision
More informationChapter 12 Benefits and Covered Services
12 Benefits and Covered Services Health Choice Generations covers the same benefits covered under Original Medicare. Sometimes Medicare adds coverage for a new service during the year. Health Choice Generations
More informationBenefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC.
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network Providers Annual Maximum Out-of-Pocket Amount $2,500 The maximum out-of-pocket limit applies to all
More informationY0021_H4754_MRK1427_CMS File and Use PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract
Y0021_H4754_MRK1427_CMS File and Use 08262012 PacificSource Community Health Plans, Inc. is a health plan with a Medicare contract Section I - Introduction to Summary of s Thank you for your interest in.
More informationReporting Preventive Services & Problem-Oriented E & M in RHCs
Reporting Preventive Services & Problem-Oriented E & M in RHCs John Burns, CPMA, CEMC, CPC, CPC-I Vice President, Audit and Compliance Services John.Burns@RuralHealthCoding.com Your Faculty John F. Burns,
More informationBenefits are effective January 01, 2017 through December 31, 2017
Benefits are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Network & Out-of- Annual Deductible $0 This is the amount
More informationBenefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
More informationBenefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
More informationFLEX RETIREE MAP (Over 65 Flex Retirees) 2018 Benefits PROFESSIONAL SERVICES. Visit to a physician, physician assistant or nurse practitioner at a PPG
PROFESSIONAL SERVICES Visit to a physician, physician assistant or nurse practitioner at a PPG Periodic health evaluations/preventive services - Applies when the only service(s) provided is a Medicare
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
UnitedHealthcare Oxford Reimbursement Policy PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.19 T0 Effective Date: July 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE...
More informationBenefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
More information2013 Summary of Benefits Humana Medicare Employer RPPO
2013 Summary of Benefits Employer RPPO RPPO 079/631 Loudoun County Public Schools Y0040_GHA0B4IHH13 PPO 079/631 Thank you for your interest in the Employer Regional PPO Plan. This plan is offered by Humana
More informationMedicare & Medicare Supplemental Insurance (Medigap)
Elder Law Basics Medicare & Medicare Supplemental Insurance (Medigap) Steven A. Kass, Esq., CELA Law Office of Steven A. Kass, PC 105 Maxess Road, Suite N116 Melville, New York 11747 What is Medicare?
More informationMedicare Preventive Services
Medicare Preventive Services Presented by Part B Provider Outreach & Education December 16, 2015 Event Instructions Today s event is a teleconference Slides will not be advanced during the presentation
More informationSummary of Benefits Report SENIOR CARE PLUS: VALUE BASIC PLAN (HMO)-009 January 1, 2015 December 31, 2015 WASHOE COUNTY, NEVADA
SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare).
More informationJanuary 1, 2015 December 31, Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)
BLUECROSS BLUESHIELD SENIOR BLUE 601 (HMO), BLUECROSS BLUESHIELD SENIOR BLUE HMO SELECT (HMO) AND BLUECROSS BLUESHIELD SENIOR BLUE HMO 651 PARTD (HMO) (a Medicare Advantage Health Maintenance Organization
More informationInitial Preventive Physical Examination (IPPE) Presented by Provider Outreach and Education (POE) December 2016
Initial Preventive Physical Examination (IPPE) Presented by Provider Outreach and Education (POE) December 2016 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC
More informationRECOVERY AUDIT CONTRACTORS
RECOVERY AUDIT CONTRACTORS RAC SUBSCRIPTION SERVICE Being Proactive Telemedicine Rule and CMS Updates May 10, 2011 2011 Aegis Compliance & Ethics Center, LLP 1 Faculty Brian Annulis, JD Partner, Meade
More informationHealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin
HealthPartners Freedom Plan 2011 Medical Summary of Benefits Wisconsin HealthPartners Wisconsin Freedom Plan I HealthPartners Wisconsin Freedom Plan II 420421 (10/10) H2462_SB WI_151 CMS Approved 10/5/10
More informationSUMMARY OF BENEFITS. Cigna-HealthSpring. Advantage SMS (HMO) H January 1, December 31, Cigna H4407_16_32690 Accepted
SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Advantage SMS (HMO) H4407-011 2015 Cigna H4407_16_32690 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet
More informationSelect Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2015 - December 31, 2015 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what
More informationMedicare Basics. Part I of II
Part I of II August 2013 1 What are the Four Parts of Medicare? Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans, like HMOs and PPOs Includes Part A & B and usually Part
More informationENGAGING IN FINANCIAL IMPROVEMENT FOR THE FUTURE
Ralph Llewellyn, CPA, CHFP Partner rllewellyn@eidebailly.com 701.239.8594 ENGAGING IN FINANCIAL IMPROVEMENT FOR THE FUTURE CONTEXT Increasing number of critical access hospitals and other rural providers
More informationOur service area includes the following county in: Delaware: New Castle.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H3113-011 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationACO S SUCCESS AND IMPACTS ON FINANCE AND REVENUE CYCLE
Ralph Llewellyn, CPA, CHFP Partner rllewellyn@eidebailly.com 701.239.8594 ACO S SUCCESS AND IMPACTS ON FINANCE AND REVENUE CYCLE CONTEXT Increasing number of critical access hospitals and other rural providers
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Jade (HMO SNP) Kern, Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0175 CMS Accepted 09082015
More informationReimbursement Environment
Reimbursement Environment 1 2017 Medicare Physician Fee Schedule Enhancing Integrative Medicine: CMS adopting additional care management codes in 2017 MPFS. Support patient centered and collaborative strategies.
More informationMedicare Plus Blue SM Group PPO. Summary of Benefits. Michigan Public School Employees Retirement System
2018 Medicare Plus Blue SM Group Summary of Benefits January 1, 2018 December 31, 2018 Michigan Public School Employees Retirement System www.bcbsm.com/mpsers This information is a summary document and
More informationHMO Basic (HMO) / HMO 40 (HMO) / HMO 20 (HMO) Summary of Benefits
/ / Summary of Benefits January 1, 2015 December 31, 2015 Call toll-free 1-800-965-4022 8 a.m. to 8 p.m. daily October 1 to February 15 and 8 a.m. to 8 p.m. weekdays the rest of the year. TTY/TDD 711 HealthAllianceMedicare.org
More informationIllustrative Benefits, Value Added Services and Premiums are effective January 1, 2016 through December 31, 2016
PLAN FEATURES Combined In and Out of Network Deductible (Plan Level/includes Network Deductible) Network & Out-of-Network Providers $0 Member Coinsurance N/A Applies to all expenses unless otherwise stated.
More informationINTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS
INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS January 1, 2015 - December 31, 2015 CARE1ST HEALTH PLAN California: Fresno, Merced, Stanislaus and San Joaquin Counties H5928_15_029_SB_CTCA_2
More informationSummary of Benefits 2018
SM Summary of Benefits 2018 bluecareplus.bcbst.com H3259_18_SB Accepted 08282017 This is a summary of drug and health services covered by BlueCare Plus (HMO SNP) SM health plan January 1, 2018 - December
More informationRHC Billing for Provider-Based RHCs. Charles A. James, Jr. President and CEO North American Healthcare Management Services
RHC Billing for Provider-Based RHCs Charles A. James, Jr. President and CEO North American Healthcare Management Services Presentation Objectives Provider-Based Requirements Provider-based Enrollment Issues
More informationIntensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services
Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Index Stand Alone Benefit 2 G Codes for Intensive Behavioral Therapy 3 The content of the Intensive Behavioral
More informationOur service area includes these counties in:
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Nursing Home Plan (HMO SNP) H5253-042 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationSignal Advantage HMO (HMO) Summary of Benefits
Signal Advantage HMO (HMO) Summary of Benefits January 1, 2016 December 31, 2016 The provider network may change at any time. You will receive notice when necessary. This information is available for free
More informationSummary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO
2009 Health Net Summary of benefits Los Angeles, Orange, Riverside and San Bernardino counties s effective January 1, 2009 H0562 Medicare Advantage HMO Material ID H0562-09-0041 CMS Approval 9/08 Section
More informationPersonal Health Care Journal
Personal Health Care Journal U.S. Administration on Aging Take an active role in your own health care! Protect Detect Report Protect Your Personal Information Treat your Medicare, Medicaid and Social Security
More informationCLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW
Diplomate: CLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW A. INFORMATION MANAGEMENT 1. Does your practice currently use an electronic medical record system? Yes No 2. If Yes, how long has the
More informationOur service area includes these counties in: North Carolina: Durham, Wake.
2018 SUMMARY OF BENEFITS Overview of your plan AARP MedicareComplete (HMO) H5253-039 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service or go
More informationMedicare Annual Wellness Guide
Medicare Annual Wellness Guide 1 Background Established in 2010 through the Affordable Care Act, this benefit was designed to encourage monitoring of physical and cognitive abilities, as well as development
More informationBenefits and Premiums are effective January 01, 2019 through December 31, 2019 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2019 through December 31, 2019 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
More informationMEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.
ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction
More informationSummary of Benefits Advantra Freedom PEBTF
Advantra Freedom is a Medicare Advantage Private Fee-For-Service (PFFS) Plan. This Summary of Benefits tells you some features of our Plan. It doesn't list every service that we cover or list every limitation
More informationSummary Of Benefits. WASHINGTON Pierce and Snohomish
Summary Of Benefits WASHINGTON Pierce and Snohomish 2018 Molina Medicare Choice (HMO SNP) (800) 665-1029, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local time H5823_18_1099_0007_WAChoSB Accepted 9/26/2017
More informationSummary of Benefits for SmartValue Classic (PFFS)
Summary of Benefits for SmartValue Classic (PFFS) Available in Select Counties in Nevada A health plan with a Medicare contract. Rocky Mountain Hospital and Medical Service, Inc. has contracted with the
More informationOur service area includes these counties in: Texas: Aransas, Kleberg, Nueces, San Patricio.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete Focus (HMO SNP) H4527-004 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationSummary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP)
Summary of Benefits for Available in: Select Counties* in Maine *See Page 2 for a list of counties. Plan year: January 1, 2018 December 31, 2018 In this section, you ll learn about some of the benefits
More informationA WORD TO OUR PATIENTS ABOUT MEDICARE AND WELLNESS CARE
A WORD TO OUR PATIENTS ABOUT MEDICARE AND WELLNESS CARE Dear Patient, We want you to receive wellness care health care that may lower your risk of illness or injury. Medicare pays for some wellness care,
More informationSmartSaver. A Medicare Advantage Medical Savings Account Plan. Summary of Benefits and Other-Value Added Services. From Blue Cross of California
SmartSaver From Blue Cross of California A Medicare Advantage Medical Savings Account Plan Service Area C Summary of Benefits and Other-Value Added Services H5769 2007 CO 415 09/22/06 Introduction to the
More informationCorrection Notice. Health Partners Medicare Special Plan
Correction Notice Special Plan Following are corrections that apply to both the English and Spanish versions of the 2015 for Special (HMO SNP): Original Information Page 1, under the heading SECTIONS IN
More informationClassic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO)
January 1, 2016 December 31, 2016 Classic Plan Value Plan Rewards Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover
More informationOur service area includes the following county in: Florida: Miami-Dade.
2018 SUMMARY OF BENEFITS Overview of your plan Medica HealthCare Plans MedicareMax (HMO) H5420-001 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationExplorer Plan (HMO-POS) SunSaver Plan (HMO-POS)
January 1, 2015 December 31, 2015 Explorer Plan SunSaver Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More informationOur service area includes these counties in: Arizona: Apache, Coconino, Maricopa, Mohave, Navajo, Pinal, Yavapai.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete ONE (HMO SNP) H0321-004 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationPiedmont Access to Health Services. Standing Orders for Patient Work-ups
Piedmont Access to Health Services Policy Number: 01-09-014 SUBJECT: Standing Orders for Patient Work-ups EFFECTIVE DATE: 8/3/09 REVIEWED/REVISED : 4/10/2012 POLICY: PATHS is committed to allowing each
More informationOur service area includes these counties in:
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete ONE (HMO SNP) H3113-012 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More informationFee-For-Service Population Health Management Services: Getting Paid Now to Prepare for the Future
Fee-For-Service Population Health Management Services: Getting Paid Now to Prepare for the Future No portion of this white paper may be used or duplicated by any person or entity for any purpose without
More informationBlue Cross Medicare Private Fee For Service. Summary of Benefits. January 1, 2018 December 31, 2018
Blue Cross Medicare Private Fee For Service Summary of Benefits January 1, 2018 December 31, 2018 This information is not a complete description of benefits. Contact the plan for more information. To get
More informationExplorer Plan (HMO-POS) SunSaver Plan (HMO-POS)
January 1, 2016 December 31, 2016 Explorer Plan SunSaver Plan SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More informationVIVA MEDICARE Select (HMO)
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR VIVA MEDICARE January 1, 2014 - December 31, 2014 Central Alabama and Mobile Area Thank you for your interest in. Our plan is offered by Viva Health, Inc., which
More informationHealth First Wellness Incentive
Health First Wellness Incentive The Health First Wellness Incentive has been set up as a reward for taking steps to either maintain or obtain a healthy lifestyle. Taking healthy actions and becoming a
More informationSelect Summ ary. VIVA MEDICARE Plus Select (HMO) INTRODUCTION TO THE SUMMARY OF BENEFITS FOR. You have choices in your health care.
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR VIVA MEDICARE Plus January 1, 2013 - December 31, 2013 Central Alabama and Mobile Area Thank you for your interest in. Our plan is offered by Viva Health, Inc./,
More informationOur service area includes the 50 United States, the District of Columbia and all US territories.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Group Medicare Advantage (PPO) Group Name (Plan Sponsor): NEW ENGLAND ANNUAL CONF OF THE METHODIST CHURCH Group Number: 13850 H2001-816 Look
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationFREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services
FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California
More informationSpecific Payment Codes for the Federally Qualified Health Center (FQHC) PPS
Specific Payment Codes for the Federally Qualified Health Center (FQHC) PPS In accordance with Section 1834(o)(1)(A) and 1834(o)(2)(C) of the Social Security Act, we established specific payment codes
More informationRick Bikowski MD Chief Quality Officer, EVMS Medical Group CARE MANAGEMENT
Rick Bikowski MD Chief Quality Officer, EVMS Medical Group CARE MANAGEMENT Medicare Wellness Visit: Background Until recently, Medicare did not pay for preventive services Welcome to Medicare visit initiated
More informationOur service area includes Florida.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP) R7444-013 Look inside to learn more about the health services and drug coverages the plan provides.
More informationOur service area includes these counties in:
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H0432-009 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More information2018 SUMMARY OF BENEFITS
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Group Medicare Advantage (PPO) H2001-827 Group Name: North Carolina State Health Plan for Teachers and State Employees Group Numbers: 12309,
More informationNextGen Preventative Exam Template
NextGen Preventative Exam Template Summary This guide describes the use of the Preventive Exam HPI template to document both the initial Welcome to Medicare Exam and subsequent Annual Wellness Visits.
More informationEarly and Periodic Screening, Diagnosis and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) EPSDT and Bright Futures: Virginia VIRGINIA (VA) Medicaid s EPSDT benefit provides comprehensive health care services to children under age
More informationGeorgiaCares Program. Presenter: Christine J. Williams, SHIP Coordinator. Georgia Department of Human Services
GeorgiaCares Program Presenter: Christine J. Williams, SHIP Coordinator Georgia Department of Human Services DHS Vision, Mission and Core Values Vision Stronger Families for a Stronger Georgia. Mission
More informationOur service area includes these counties in: Florida: Broward, Miami-Dade.
2018 SUMMARY OF BENEFITS Overview of your plan Preferred Medicare Assist (HMO SNP) H1045-012 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service
More information2018 SUMMARY OF BENEFITS
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Senior Care Options (HMO SNP) H2226-001 Look inside to learn more about the plan and the health and drug services it covers. Call Customer
More informationNCD for Routine Costs in Clinical Trials (310.1)
NCD for Routine Costs in Clinical Trials (310.1) Publication Number 100-3 Manual Section Number 310.1 Version Number 2 Effective Date of this Version 7/9/2007 Implementation Date 10/9/2007 Benefit Category
More information2018 Summary of Benefits
2018 Summary of Benefits H5209-004_MDASB 9-13-17 Accepted 9/18/2018 DHS Approved 09/13/2017 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP)
More informationInformation for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)
Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2011 December 31, 2011 Los Angeles County This publication is a supplement to the 2011 Positive (HMO SNP) Evidence
More information2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
More information2018 MA Plan 006. Alternative Medicine:Acupuncture and Naturopathy. $250 maximum combined total of acupuncture and naturopathy services
Abdominal Aortic Aneurysm Screening $0 copay For planned preventive services that become diagnostic during the Alternative Medicine:Acupuncture and Naturopathy AIR Ambulance (Non-emergency) $300.00 copay
More informationSNF Consolidated Billing Exclusions/Inclusions
SNF Consolidated Billing Exclusions/Inclusions Under SNF consolidated billing rules, certain Part B services provided to SNF residents are to be billed directly by the SNF. The facility would bill the
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationCRCS Exam Study Manual Update for 2018
CRCS Exam Study Manual Update for 2018 This document reflects updates made to the instructional content from the Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Manual - 2017 to the 2018
More informationSummary Of Benefits January 1, December 31, 2014 Optima Medicare Optima Medicare Basic HMO Optima Medicare Enhanced HMO
Summary Of Benefits January 1, 2014 - December 31, 2014 Optima Medicare Optima Medicare Basic HMO Optima Medicare Enhanced HMO www.optimahealth.com/medicare Table of Contents 3 Letter from Michael Dudley,
More informationExtra Value Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2016 - December 31, 2016 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what
More informationHEALTH CARE BENEFITS YOU CAN COUNT ON. Retired Employees Health Program (REHP)
HEALTH CARE BENEFITS YOU CAN COUNT ON 2014 Retired Employees Health Program () PEBTF_2014 Thank you for your interest in Geisinger Gold Classic. Our plan is offered by Geisinger Health Plan/Geisinger Gold
More informationBuilding Ambulatory Clinical Pharmacy Services: Demonstrating Value. Amy L Stump, PharmD, BCPS October 17, 2012
Building Ambulatory Clinical Pharmacy Services: Demonstrating Value Amy L Stump, PharmD, BCPS October 17, 2012 1 Objectives Develop a list of outcomes that could be used to determine the benefit of a pharmacist
More informationQuality Measurement at the Interface of Health Care and Population Health
1 Institute of Medicine Committee on Quality Measures Healthy People Leading Health Indicators December 10, 2012 Quality Measurement at the Interface of Health Care and Population Health Shari M. Ling,
More information2012 Summary of Benefits
North Carolina Network Private-Fee-For-Service 2012 N12SB42680102 Charlotte Rale SB Combo 001-002 001 - Patriot (PFFS) 002 - Patriot Plus (PFFS) Counties: Caswell, Cleveland, Durham, Granville, Guilford,
More informationSummary Of Benefits. Molina Medicare Options Plus (HMO SNP) (866) , TTY/TDD days a week, 8 a.m. 8 p.m. local time
Summary Of Benefits OHIO Brown, Butler, Clark, Clermont, Clinton, Columbiana, Delaware, Fairfield, Fayette, Franklin, Greene, Hamilton, Highland, Hocking, Lake, Madison, Miami, Montgomery, Morrow, Perry,
More informationTelehealth. Administrative Process. Coverage. Indications that are covered
Telehealth These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information
More information2018 Electric Boat Retiree Medical Plan Options
2018 Monthly Medical Plan Cost 2018 Monthly Plan Cost including Limited Rx $233.60 $172.00 $142.00 $322.99 $261.39 $231.39 2018 Monthly Plan Cost including Unlimited Rx Out-of-Pocket Plan Maximum (OOP
More informationSummary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties
Summary of Benefits New York: Bronx, Kings, New York, Queens and Richmond Counties January 1, 2006 - December 31, 2006 You ve earned the right to live life on your own terms. And that includes the right
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationChronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky
Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements
More informationTrue Blue Special Needs Plan (HMO SNP)
True Blue Special Needs Plan (HMO SNP) 2012 Summary of Benefits You think about finding the perfect health insurance plan. We think about providing you with seamless service and affordable benefits. Serving
More informationSUMMARY OF BENEFITS 2009
HEALTH NET VIOLET OPTION 1, HEALTH NET VIOLET OPTION 2, HEALTH NET SAGE, AND HEALTH NET AQUA SUMMARY OF BENEFITS 2009 Southern Oregon Douglas, Jackson, and Josephine Counties, Oregon Benefits effective
More information