It is often observed that patient’s assume by themselves that annual checkup would be free, and the cost of that checkup would be paid under Medicare charges.
Actually, annual physical exam is not covered under Medicare charges. It leads the patients to argue with their health mentors, and they blame that there would be a billing error or some other technical issues with the medical bills, but actually Medicare have separate regulations for regular and annual physical examination.
What is included in the Medicare wellness program?
The provider would use the healthcare facilities of Medicare for the following reasons;
Medicare will pay the physicians to perform diagnoses for a patient’s ailments and disorders for the usual physical checkup. As, the main focus of Medicare is to prevent diseases and physical disability by introducing a “personalized prevention plan” for future medical issues based on the beneficiary’s health and risk factors.
2. Billing diagnosis:
At the initial level, patients will often fill out a risk-assessment questionnaire and review their family and personal medical hierarchy and interaction with their doctor, a nurse practitioner or physician assistant. The health care providers schedule for further mammograms, colonoscopies and other screenings and evaluate people for cognitive problems and depression along with the risk of physical falls and other safety issues.
3. Referral codes:
The medical business will use referral codes for their medical appointment tasks. It will help them to keep the record of patient’s visits schedule and every subtle detail of the patient’s appointment is kept and processed by medical billing and coding specialists.
4. Patient’s insurance plan number:
Patient’s payables are mentioned as co-pays amount which is defined by the plan subscribers against a unique insurance plan number. It covers the following services of the physician;
- Deductibles: This amount is paid before health insurance plan’s execution for doctor’s claims; coinsurance, a percentage of healthcare costs that the insured must pay even after they’ve met their deductible.
- Co-pays: Health insurance plans have fixed co-pays. It is the amount that is predefined for physician’s services subscription fees. That patient’s pay via themselves, secondary payers or third-party payers.
- Coinsurance: It is the amount that is prefixed for a particular medical claim after the deductible is satisfied. It is similar to co-payment, with an exception that co-payment needs the third-party payers to pay at the time of services received by the patient.
- Advance care planning: Advance care planning covers the beneficiaries to decide the type of medical treatment that is expected to be received by the patient, in the future. Beneficiaries can also receive payments for the preventive services they receive from the physician
When the Medicare program was established long ago, its aim was to cover the diagnosis and treatment of illness and injury in adult population. Preventive services were performed generally, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids but Medicare covers the annual wellness visits that are only registered by the physician suggested by Medicare.
However, if an individual deviates visits to the physician’s office for wellness checkup other than the services specified by Medicare, then Medicare beneficiaries will owe a co-pay or other charges. Medicare covers the cost of medical services for patients of all ages, while the ACA requires insurers to provide coverage, without a copay, for the specific range of preventive services, including immunizations. But if a visit goes beyond prevention, the patient may encounter charges.
Plans covered by Medicare:
1. Many patients want their doctor to evaluate or treat chronic ailments including; diabetes, arthritis and other severe ailments, Medicare covers the prevention cost of all of these services. But it generally won’t pay for lab work cholesterol screening, unless it’s tied to a specific medical condition. Many patients acknowledge that they have gone through the situations when Medicare may not pay for some of the services they receive. Hence, they easily understand that they can’t afford to revisit the health care faculty again for the services, so they prefer to pay extra dues in a single visit.
2. Beneficiaries and physicians are unclear about the payables until Medicare define them the services they cover.
Note: According to the recent study published in the journal Health Affair in 2015: Just over half of health care practitioners with eligible Medicare patients didn’t cover the annual wellness visit. The analysis found that 18.8% of eligible beneficiaries received an annual wellness visit in the time the survey was conducted.
3. They also cover the primary care services received by the patient more often that helps the patients to keep up with the health improvement of their patients.