Tool Helps FPs Get Paid for Medicare Preventive Services

AAFP Guide Reviews Services Free of Patient Deductibles, Coinsurance Payments

February 08, 2012 11:10 am Sheri Porter

On Jan. 1, a provision of the Patient Protection and Affordable Care Act kicked in that requires certain preventive services family physicians provide for their Medicare patients to be covered without patient deductibles or coinsurance payments.

To help ensure members get paid for providing the identified preventive services -- alcohol screening, depression screening, behavioral counseling to prevent sexually transmitted infections, counseling to reduce cardiovascular disease risk and counseling for obesity -- the Academy has created an online tool that reviews these services.

The AAFP tool lists each new benefit covered without deductible or coinsurance costs to the patient, the number of relative value units and the "G" procedure code assigned to that benefit, and all relevant coverage information. It also includes links to pertinent CMS MLN Matters articles, as well as links to CMS national coverage decisions.

Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist, told AAFP News Now that members were calling the Academy with questions about the new preventive services. "This resource reflects the information that the Academy has in hand so far, and we will update the tool with new information as it becomes available," said Hughes. She added that CMS could publish edits for some or all of the codes later this year. Those edits could involve bundling some of the preventive services with the provision of other services, such as problem-oriented office visits.

However, "Members who are providing these preventive services should continue to do so and should bill them according to directions currently available because any future edits made by Medicare that could change the payment structure would not be retroactive," said Hughes.

She also pointed out that some of the Medicare counseling and behavioral therapy benefits included in the services require physicians to use a technique dubbed the "Five As(," a concept originally developed as the "Four As" by the National Cancer Institute to guide physician intervention in smoking cessation and later adapted by the Canadian Task Force on Preventive Health Care to add a fifth "agree" step. Most recently, the technique has been embraced by the U.S. Preventive Services Task Force. It consists of the following steps:

  • Assess: Ask about/assess behavioral health risks and factors affecting choice of behavior.
  • Advise: Give clear, specific and personalized behavior change advice.
  • Agree: Collaboratively select appropriate treatment goals and methods.
  • Assist: Use behavior change techniques, such as self-help and/or counseling, to aid patients in achieving agreed-upon goals.
  • Arrange: Schedule follow-up contacts to provide ongoing assistance and support.

Hughes suggested that physicians go over the technique with their staff members and determine how to document for coding purposes its various components.