decisionhealth Newsletters, Part B News - 2011 Issue 1 (January)
3 keys to take advantage of preventive services without copays
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Article Overview
This article explains how a health reform-era preventive services policy affects patient cost sharing and practice workflows. It is aimed at physicians, practice managers, and coding/billing staff who schedule screenings, educate patients, and handle claims when a preventive visit changes to a diagnostic or treatment encounter. The discussion covers broad preventive service categories, payer rules, and the need to prepare patients for possible changes in coverage during the same visit.
Why This Topic Matters
It helps practices communicate preventive benefits clearly, avoid patient confusion, and anticipate claim and cost-sharing issues when a screening uncovers a problem.
Article Sections
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Preventive services covered without copays or deductibles
Introduces the policy context for preventive services under health reform and the role of federal coverage criteria. Summarizes the scope of the services affected and the types of patients most likely to be impacted.
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Spread the word to patients
Discusses patient communication strategies and outreach approaches for informing patients about preventive service coverage changes. Also addresses common screening types and the importance of scheduling routine preventive care.
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Focus on getting more patients up to date on screenings
Covers practice efforts to encourage patients to complete recommended screenings and prepare staff to answer questions about coverage and screening frequency requirements. Addresses the operational impact of preventive-service awareness in primary care settings.
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Have a plan for screenings that turn up problems and no longer stay free
Explains the need to prepare patients for situations in which a screening encounter changes because a problem is found. Discusses the general billing and communication implications of that change for the same visit.
What You Will Learn
- How preventive service coverage changes can affect patient communication
- Why screening outreach matters for practice workflow
- What to consider when a preventive screening encounter becomes more complex
- How payer requirements can affect preventive service cost sharing
- Why practices should prepare patients for possible changes during screening visits
Who Should Read This
- Physicians
- Practice managers
- Office staff
- Medical coders
- Billing staff
- Healthcare administrators
Codes Discussed
Modifiers Discussed
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