Dear CMS: Practices suggest 8 changes to ‘Welcome to Medicare'

Why This Topic Matters

The article helps readers understand why utilization of the preventive exam has been limited and what operational, policy, and payment issues practices are raising with CMS. It also frames the service within Medicare preventive care and basic billing considerations that affect how practices report the visit and associated services.

Article Sections

1. Overview and stakeholder feedback

   Introduces the Medicare preventive exam and summarizes the broad concerns raised by physicians, administrators, and specialty organizations about how the service is working in practice.

2. Recommendations to simplify and redesign the service

   Covers suggestions related to making the preventive visit easier to perform, including comments about the structure of the service and its underlying design.

3. Clinical judgment, patient intake, and operational workflow

   Discusses recommendations about patient questioning, identifying eligible patients, and how practices can organize intake and outreach for the benefit.

4. Eligibility, cost-sharing, patient education, and payment

   Summarizes proposals involving enrollment timing, cost-sharing, patient awareness, and reimbursement levels for the service.

5. Preventive services to which patients are referred

   Lists the broader preventive service categories associated with the exam and the types of follow-up care that may be involved.

6. Billing and coding instructions

   Provides general billing guidance for reporting the preventive visit and related electrocardiogram services, plus notes about diagnosis coding and common reporting scenarios.

7. Scenarios

   Presents example situations showing how the visit and related services may be documented and reported in different workflow arrangements.