An audio recording and transcript are available for the August 20 Medicare Learning Network call on the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP): CY 2020 ESRD PPS (Prospective Payment System) Proposed Rule Call. Learn about the legislative framework, the proposed rule, and methods for reviewing and commenting on the rule.
Individuals new to Medicare should schedule a “Welcome to Medicare” preventive visit. Medicare Part B covers a FREE comprehensive screening within the first 12 months of having Part B.
Individuals who have had Medicare Part B for longer than 12 months can get a FREE yearly “Wellness” visit once every year to develop or update a personalized prevention plan.
Patients pay nothing if their doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply. However, patients may have to pay coinsurance, and the Part B deductible may apply, if doctors or other health care providers perform additional tests or services during the same visit that are not covered under the preventive benefits.
When making the appointment, patients should let the doctor’s office know a “Welcome to Medicare” preventive visit would like to be scheduled. It is also important to know what to bring to the “Welcome to Medicare” preventive visit.
The preventive visit includes a review of medical and social history related to the patient’s health, along with education and counseling about preventive services. It can also include:
- Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
- Height, weight, and blood pressure measurements.
- A calculation of your body mass index.
- A simple vision test.
- A review of your potential risk for depression and your level of safety.
- An offer to talk with you about creating advance directives.
- A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.
The yearly “Wellness” visit is designed to help prevent disease and disability based on current health and risk factors. Providers will ask patients to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. It can also include:
- A review of your medical and family history.
- Developing or updating a list of current providers and prescriptions.
- Height, weight, blood pressure, and other routine measurements.
- Detection of any cognitive impairment.
- Personalized health advice.
- A list of risk factors and treatment options for you.
- A screening schedule (like a checklist) for appropriate preventive services.
- Advance care planning
By collaborating with physicians/practices that performs a comprehensive review of health status, the medical team at the dialysis clinic can be assured that patients have an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.
CMS is pleased to invite the public to attend its upcoming webinar titled Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement. The webinar will provide an engaging and informative overview of key concepts that go into its quality measures. Additionally, the presentation will review current CMS quality measures, explain how they are used, and how they fit into CMS’s quality goals, including the Meaningful Measures initiative.
The webinar will be offered twice in June, on Tuesday, June 25th, from 2:00-3:00pm EST (Register here) and Thursday, June 27th, from 2:00-3:00pm EST (Register here). Please register in advance if you can attend as space will be limited. CMS requests that interested individuals only register for the event they’re able to attend. CMS looks forward to participant questions!
For questions, please contact MMSSupport@battelle.org.
May is Mental Health Month. Raise awareness by talking about mental health conditions. Recommend appropriate preventive services, including the Initial Preventive Physical Examination, Annual Wellness Visit, and Depression Screening.
For More Information:
- Medicare Preventive Services Educational Tool
- Initial Preventive Physical Examination Booklet
- Annual Wellness Visit Booklet
- Centers for Disease Control and Prevention Mental Health website
Visit the Preventive Services website to learn more about Medicare-covered services.
CMS will present a February 6, 2019 Open Door Forum call on the new Medicare card. For details see https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2019-01-31-eNews.html DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc536597350.
If you have patients who are new to Medicare, encourage them to schedule their “Welcome to Medicare” physical exam. This is a FREE comprehensive screening that will ensure
- A record and evaluation of their medical and family history, current health conditions, and prescriptions.
- Baseline measures of blood pressure, vision, weight, and height.
- Review of preventive screenings and services, like cancer screenings and immunizations.
- Ordering of additional tests, if needed, depending on their general health and medical history.
After the visit, the doctor will give them a plan or checklist outlining free screenings and preventive services that they need. By collaborating with the physician/practice that performs the comprehensive review of the patient’s health status, the medical team at the dialysis clinic can be assured that the patient has an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.
For more information, see: https://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html
The Centers for Medicare & Medicaid Services (CMS) recently released 2018 benefit and premium information as well as Star Ratings for Medicare health and drug plans. Changes announced represent more health coverage choices, improved access to high-quality health choices, and decreased premiums in 2018. “Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma.
The following resources have been created to assist patients with understanding health coverage options:
- 2018 Medicare Parts A & B Premiums and Deductibles: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-17.html
- 2018 Medicare Advantage and Part D Star Ratings:http://go.cms.gov/partcanddstarratings
- Medicare Advantage and Part D Prescription Drug Program: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-09-29.html
- Prescription Drug Coverage: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html
For more information about the CMS health coverage announcement, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-10-11.html
For information on proposed policy changes and updates for Medicare Advantage and the Prescription Drug Benefit Program for 2019, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-16.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
Medicare offers prescription drug coverage to everyone with Medicare. If your patients decide not to get Medicare drug coverage when they are first eligible, they may be asked to pay a late enrollment penalty unless they have other creditable prescription drug coverage or are receiving Medicare’s Extra Help.
Every year, Medicare’s open enrollment period is October 15 – December 7. Medicare health and drug plans can make changes each year. These changes could affect the cost, coverage, and the providers and pharmacies in their networks. You can assist your patients by discussing their Medicare Part D coverage and timelines for the ESRD coordination of benefits period to ensure that they are prepared for the year to come.
To research Medicare drug plans use the Medicare Plan finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx
Helpful resources for your patients:
- Visit https://www.medicare.gov/find-a-plan to compare current coverage with all of the options in the area.
- Review the Medicare & You 2018 handbook at https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf.
- Patients with limited income and resources may be able to get extra help paying prescription drug costs. For more information, visit https://secure.ssa.gov/i1020/start.
- Get one-on-one help from the State Health Insurance Assistance Program (SHIP). Visit https://www.medicare.gov/contacts/.
- In 2018, patients who reach the “donut hole” in Medicare’s prescription drug benefit (Part D) can save 60% on covered brand-name drugs and see increased savings on generic drugs while in the donut hole. Visit: https://www.medicare.gov/part-d/
Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative CMS seeks to prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of Medicare beneficiaries.
CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.
Please click here to read the full article and learn the five steps to prepare your facility to get ready.