Do you go for annual Medicare preventive tests and screening?

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Lynette
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Do you go for annual Medicare preventive tests and screening?

Post by Lynette » Sun Aug 19, 2018 6:51 pm

I was wondering how many medicare-eligible people go for the annual Medicare preventive tests and screening. I got an email from Medicare that I had not been for 18 months. It was not my intention to go this year as I don't think I have any major issues. My reluctance to go stems from the saga I went through with billing for my Welcome to Medicare last year. As I worked till 73 instead of the standard 65, every possible error that could be made was made. It took eons to get doctor's billing codes correct, deal with Medicare denial as my long-term doctor did not give me tests Medicare thought was necessary for a new patient etc. etc.

Is Medicare aware of how long ago certain tests were done or does the clock start again? For example, unless one has major issue, my former plan covered a colonoscopy every five years. I don't want to go through all the tests again just to satisfy Medicare. My doctor was dinged by Medicare as he did not give me an EKG for a Welcome to Medicare. I have been with him for over 20 years and he knows my health - but Medicare doesn't!

drawpoker
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Re: Do you go for Medicare preventive tests and screening?

Post by drawpoker » Sun Aug 19, 2018 7:02 pm

I feel exactly the same.
Pick and choose, you know your own health better than the gumbmint does.
Being female, I will go for the bone scans to check for osteoporosis since that is a known risk for me. Also, go for the annual dermatology exam to screen for skin cancer. But I can readily skip colonoscopy and others.

Wanna hear a good one? Some seniors are so confused by all the Medicare blasts of spam about not using these benefits that someone posted on a AARP message board recently. Are the free Medicare preventive screenings mandatory? Is it the law I must have them?

Poor soul. Worked themselves into a lather worrying they might be breaking the law. :o :o

retiredjg
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Re: Do you go for annual Medicare preventive tests and screening?

Post by retiredjg » Sun Aug 19, 2018 7:22 pm

I'd like to hear more about "my doctor was dinged by Medicare". This was mentioned at my last doctor visit. I wasn't sure what he meant.

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munemaker
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Re: Do you go for annual Medicare preventive tests and screening?

Post by munemaker » Sun Aug 19, 2018 7:28 pm

I have been going every year under ObamaCare. I will be on Medicare for next year's wellness exam and plan to continue yearly. While my health is very good, it is a chance to have my blood tested and chat with my doc about my marginal cholesterol level and other minor issues.

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GerryL
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Re: Do you go for annual Medicare preventive tests and screening?

Post by GerryL » Sun Aug 19, 2018 7:36 pm

Just a reminder for those soon to go on Medicare: After that initial "Welcome to Medicare" visit, the annual "Wellness Visit" is NOT a physical exam. It's mostly a chance to talk with the doc and possibly set up subsequent visits to investigate any physical complaints you may bring up. If the Wellness Visit becomes an exam, it may no longer be cost-free. I think many docs are getting clued into this now and don't mix Wellness and exam together on the same visit.

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nisiprius
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Re: Do you go for annual Medicare preventive tests and screening?

Post by nisiprius » Sun Aug 19, 2018 7:42 pm

I always went for an "annual physical" and under (traditional) Medicare I go for my "annual wellness visit."

I don't know what goes on behind the scenes with coding and so forth, but the only difference between my "wellness visits" and my former "physicals" is the addition of, perhaps, a fifteen-minute interview conducted by a medical professional who is not a doctor, where they do some really basic assessments (pssst: the answers are "apple, table, penny" and "DEFPOTEC"), and see if I can rise from a chair and walk across the room unaided. All the same things that used to be done at my "physical"--EKG every few years, a big panel of blood tests, ten minutes of poking and prodding, the rubber hammer tap on the knee, and so forth--get done, and Medicare so far has always approved the payments.
GerryL wrote:
Sun Aug 19, 2018 7:36 pm
The annual "Wellness Visit" is NOT a physical exam. It's mostly a chance to talk with the doc and possibly set up subsequent visits to investigate any physical complaints you may bring up. If the Wellness Visit becomes an exam, it may no longer be cost-free.
I worried about this, but all I can say is that my "wellness visits" do "become exams" and so far Medicare has paid for them.

My doctors have their own records and I pretty much trust whatever they say is the right interval for phragmatometries, omphaloscopies, and PDPZs.* As it happened, I was with the same doctor for fifteen years and my transition to Medicare happened during that period, so there was pretty good continuity of records.

Medicare, of course, has records of every procedure they pay for. There is also, or are also, one (or more?) voluntary data sharing agreements that they noodge you to opt into. They have confusing names, like Quality Improvement Metric Performance Assessment Measuring Program, and I am quite unsure about how gets what information about what, but I think if you participate, then any time you see a doctor who's a Medicare provider, they get to see basic information about other visits you've made to other doctors. After brooding about this, I decided that in real life it was better not to stand on principle and opt out out of contrariness, so I signed the forms.

*No, there are no such things, I just prefer not to talk about my real procedures
Last edited by nisiprius on Sun Aug 19, 2018 7:55 pm, edited 2 times in total.
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friar1610
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Re: Do you go for annual Medicare preventive tests and screening?

Post by friar1610 » Sun Aug 19, 2018 7:53 pm

I go faithfully every year. I get lab tests and I don't seemed to get billed for them. I imagine that this is either because (1) my doc has broken the code (no pun intended) on how to code things so I don't get billed; (2) my secondary payer (TRICARE) pays for some of the the things Medicare doesn't. (I'm sure I could figure this all out from my MSNs/EOBs but, as long as they continue to say I don't owe anything I just file them).

I do have a couple of longstanding issues for which annual lab tests are given and I suppose the fact that they are following up on existing problems rather than looking for new ones means they are coded differently.
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flyingaway
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Re: Do you go for annual Medicare preventive tests and screening?

Post by flyingaway » Sun Aug 19, 2018 7:56 pm

Yes, definitely. Just got my blood lab this Friday and will see my doctor next Friday.
Strange enough, annual physical is free. But if I ask several questions during my annual physical, I receive a bill for the past two years, since the doctor treats it as an office visit. Fortunatly, I only pay $10 co-pay. I am surprised the insurance company allows that.

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celia
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Re: Do you go for annual Medicare preventive tests and screening?

Post by celia » Sun Aug 19, 2018 8:12 pm

I was "bribed" by a letter from Medicare over a year ago that my annual Wellness visit would be free AND I would get a check for $25. (I had never done a wellness visit but go for annual on-going care.) Upon reading the letter, my first thought was, what a waste of Medicare money.... So on my next visit to my family doctor, when I was being escorted in, they confirmed "You're here for your annual wellness check, aren't you?" "Whatever... OK". It didn't matter to me. But there were specific things I was there to talk about as follow-ups. I shared my self-referrals to specialists with the doctor and got some labwork and left. Medicare paid for the visit and eventually sent me the $25. But I don't think the labs were covered since they were now "not medically necessary" based on the appointment type.

On DH's next appointment, I told him not to book it as an annual Wellness visit, since most of the labs will not be covered (that he usually gets). It is hard to get someone else to understand that they need to get the doctor's office to understand that you just want "ongoing continuing care" instead. At this point, I think that is how the appt and labs need to be coded. A mismatch will end with you paying for something, as far as I can tell. At least, that's what we're doing until I learn otherwise.

I understand that if you get an annual check-up, problems can be detected earlier. But if you already know what your "problems" are, the Wellness check can backfire.

Why, oh why, do they make it so complicated? Many seniors don't even understand their own health care, let alone their billing.

Lynette
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Re: Do you go for annual Medicare preventive tests and screening?

Post by Lynette » Sun Aug 19, 2018 8:21 pm

retiredjg wrote:
Sun Aug 19, 2018 7:22 pm
I'd like to hear more about "my doctor was dinged by Medicare". This was mentioned at my last doctor visit. I wasn't sure what he meant.
My Megacorp required that we went for an annual Wellness test in order to get a discount on office visits. I have had the same PCP for over 20 years. He basically followed the rules of the Megacorp Wellness Test which is not what the Welcome to Medicare wanted. For example, he did not give me an EKG. He said that this wasn't necessary as I had had one a few years prior to this and the results had actually improved as I had been swimming. Medicare was not willing to pay the full amount for the Welcome to Medicare as I did not have an EKG and other tests they required.

I think I'll go next year. I take a statin to lower my cholestrol and my doctor's office obligingly refilled the prescription. I'm not all that impressed with this drug as I have very low blood pressure, no history of heart disease in my family, eat well and exercise. At the moment I'm doing some very strenuous gardening leveling the back yard as I was quoted $11,000 to have this done and I would lose all my landscaping! So I'm not worried about my health at this stage!

drawpoker
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Re: Do you go for annual Medicare preventive tests and screening?

Post by drawpoker » Sun Aug 19, 2018 8:50 pm

nisiprius wrote:
Sun Aug 19, 2018 7:42 pm
.......I pretty much trust whatever they say is the right interval for phragmatometries, omphaloscopies, and PDPZs.* .....
*No, there are no such things, I just prefer not to talk about my real procedures
Oh, c'mon, we're all friends here. No need to hide your phragmatometries (removal of phragmites - a very easy procedure and oft recommended as phragmites are very invasive. Particularly in our area of the country )

You were wise to get an omphaloscopy, too! Nothing to be ashamed of, everyone should be screened for omphalophobia (fear of belly buttons) One of the real dread diseases! Certainly, Should be on Medicare's radar at annual exams.

Not familiar with PDPZ's..... :?:

btw, it seems the so-called "Welcome to Medicare" first visit has a lot of doctor offices challenged. At mine, over four years ago, it came back "denied" by Medicare apparently for the same reason others here have reported: the doctor neglected to do certain things req. by Medicare.
However, I was never billed, or anything ever brought up about it. Evidently my doctor was embarrassed by the oversight, and elected to just eat the fee.

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cheese_breath
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Re: Do you go for annual Medicare preventive tests and screening?

Post by cheese_breath » Sun Aug 19, 2018 8:54 pm

I have to go the my doctor regularly to have my cholesterol tested before he will write me a new prescription for my Pravachol. So I figure he sees me enough to know if anything's wrong without more tests.
The surest way to know the future is when it becomes the past.

jayk238
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Re: Do you go for annual Medicare preventive tests and screening?

Post by jayk238 » Sun Aug 19, 2018 8:59 pm

Im so sorry u guys have to be so involved in this.

I just started my practice but thankfully my employer is well aware of these inconsistencies and makes sure the patients and front staff both are aware of what is free and what isnt and how to set it up. I am very grateful for this because i had no idea of this difference until i started.

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FrugalInvestor
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Re: Do you go for annual Medicare preventive tests and screening?

Post by FrugalInvestor » Sun Aug 19, 2018 9:12 pm

Yes I do.

I've been on Medicare for just over a year now. I had my 'welcome to Medicare' appointment last June as well as my first annual preventive visit and a colonoscopy that I was due for this June.

Notwithstanding the above, what services it says that I'm currently eligible for on the MyMedicare site makes very little sense.

I was very concerned last year because my doctor's office didn't seem to have all the answers regarding what I was eligible for or the assurances I wanted that the services would be coded correctly. After asking more questions I was passed on to higher level admin staff who assured me that all staff had just gone through thorough extensive training on these exact issues (due, I assume to changing Medicare requirements) and that the doctor and staff would handle my appointment and billings appropriately. I jotted down the name and kept my fingers crossed. To my surprise everything went well and it was smooth sailing again this year!

It's obvious that my doctor is not enamored with the system and how it impacts his interactions with his patients. But he seems to be adapting and handling both pretty well. I have a great deal of respect for him being able to do that and the concern he shows in the process.
Last edited by FrugalInvestor on Sun Aug 19, 2018 9:33 pm, edited 1 time in total.
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Bogle7
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Re: Do you go for annual Medicare preventive tests and screening?

Post by Bogle7 » Sun Aug 19, 2018 9:30 pm

Yes
KP.org is insistent.

drawpoker
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Re: Do you go for annual Medicare preventive tests and screening?

Post by drawpoker » Sun Aug 19, 2018 9:47 pm

Bogle7 wrote:
Sun Aug 19, 2018 9:30 pm
...KP.org is insistent.
Not getting this (?)
Are you saying your Kaiser MA plan insists that you get all these Medicare-dictated preventive screenings?
Or, just that Kaiser hounds you so much, to the extent, it is just easier to give in?
:?

Lynette
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Re: Do you go for annual Medicare preventive tests and screening?

Post by Lynette » Mon Aug 20, 2018 7:08 am

drawpoker wrote:
Sun Aug 19, 2018 9:47 pm
Bogle7 wrote:
Sun Aug 19, 2018 9:30 pm
...KP.org is insistent.
Not getting this (?)
Are you saying your Kaiser MA plan insists that you get all these Medicare-dictated preventive screenings?
Or, just that Kaiser hounds you so much, to the extent, it is just easier to give in?
:?
I don't know about Kaiser but when I was employed, it was virtually mandatory to go for these annual wellness tests. One got "bribed" into going by getting a lower co-pay rate. The wellness tests had to be completed by the end of March and we would get constant reminders from the HMO/PPO with whom we had enrolled if we did not go. This is why I asked the question initially.

Thanks for the replies. Now I'm confused about what is a Medicare Wellness Test and what is a physical.

Another question, please. Previously I had to go through my PCP to get referrals for anything while I was employed. Now I have AARP/UHC Medigap G. Surely I still need a referral from my PCP for colonoscopies etc.

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cheese_breath
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Re: Do you go for annual Medicare preventive tests and screening?

Post by cheese_breath » Mon Aug 20, 2018 7:15 am

Lynette wrote:
Mon Aug 20, 2018 7:08 am
Another question, please. Previously I had to go through my PCP to get referrals for anything while I was employed. Now I have AARP/UHC Medigap G. Surely I still need a referral from my PCP for colonoscopies etc.
No you don't. With maybe one or two exceptions, and I forget what they are, you don't need referrals for anything with Medicare / Medigap. But you do need to be aware of the authorized frequencies for some services. For example colonoscopies are only authorized once every ten years unless your doctor feels you need them more frequently.
The surest way to know the future is when it becomes the past.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by likegarden » Mon Aug 20, 2018 9:52 am

I get the equivalent of an annual physical as I had it in the past. I see the same doctor for about 30 years, and he knows how to code for this test to get paid by my HMO type insurance which gets paid by Medicare. I take a statin for probably 20 years and have a blood test prior to my test. Colonoscopies are necessary as you get older and will include removal of polyps if found, and thereafter it will be less than every 5 years. Polyps when not removed can lead to cancer, so do not skip on a colonoscopy.

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FrugalInvestor
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Re: Do you go for annual Medicare preventive tests and screening?

Post by FrugalInvestor » Mon Aug 20, 2018 10:43 am

cheese_breath wrote:
Mon Aug 20, 2018 7:15 am
Lynette wrote:
Mon Aug 20, 2018 7:08 am
Another question, please. Previously I had to go through my PCP to get referrals for anything while I was employed. Now I have AARP/UHC Medigap G. Surely I still need a referral from my PCP for colonoscopies etc.
No you don't. With maybe one or two exceptions, and I forget what they are, you don't need referrals for anything with Medicare / Medigap. But you do need to be aware of the authorized frequencies for some services. For example colonoscopies are only authorized once every ten years unless your doctor feels you need them more frequently.
If you've had a previous Colonoscopy the report will it will document the recommendation for the timing of your next one. Saving that report will give you the information you, your doctor and Medicare needs.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

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Re: Do you go for annual Medicare preventive tests and screening?

Post by mouses » Mon Aug 20, 2018 10:54 am

likegarden wrote:
Mon Aug 20, 2018 9:52 am
I get the equivalent of an annual physical as I had it in the past. I see the same doctor for about 30 years, and he knows how to code for this test to get paid by my HMO type insurance which gets paid by Medicare. I take a statin for probably 20 years and have a blood test prior to my test. Colonoscopies are necessary as you get older and will include removal of polyps if found, and thereafter it will be less than every 5 years. Polyps when not removed can lead to cancer, so do not skip on a colonoscopy.
I faithfully had colonoscopies, but a few years ago they changed the prep procedure from tedious to very weakening. Apparently the old stuff caused a serious problem for some people, so now it's like having prolonged diarrhea with all the weakening that involves and is especially dangerous for the elderly. I really thought I might die, so I said, never again.

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Mon Aug 20, 2018 11:06 am

Lynette wrote:
Sun Aug 19, 2018 6:51 pm
I was wondering how many medicare-eligible people go for the annual Medicare preventive tests and screening. I got an email from Medicare that I had not been for 18 months. It was not my intention to go this year as I don't think I have any major issues. My reluctance to go stems from the saga I went through with billing for my Welcome to Medicare last year. As I worked till 73 instead of the standard 65, every possible error that could be made was made. It took eons to get doctor's billing codes correct, deal with Medicare denial as my long-term doctor did not give me tests Medicare thought was necessary for a new patient etc. etc.
Is Medicare aware of how long ago certain tests were done or does the clock start again? For example, unless one has major issue, my former plan covered a colonoscopy every five years. I don't want to go through all the tests again just to satisfy Medicare. My doctor was dinged by Medicare as he did not give me an EKG for a Welcome to Medicare. I have been with him for over 20 years and he knows my health - but Medicare doesn't!
I have been on the Kaiser Medicare plan since I became Medicare eligible over seven years ago. It is very difficult (I tried) to match the letter of the Medicare rules for these things with the way Kaiser seems to do things - but Kaiser seems to not charge for anything not fully required to be no charge by Medicare. While I find very credible articles, etc. questioning the value of the annual physical, I do it every year. it is an opportunity to see my PCP in person (since I do so many things by email and phone with her), make sure the records on the computer are correct, make sure I have received immunizations and follow up with specialists. I also have some conditions that require regular tests and monitoring. In May, I asked about the new shingles vaccine - and she indicated there was a priority list because of a supply shortage. I think that because I asked she may have bumped me up a bit and I got the shingles shot that day - followed by the required second shot this morning.

Although I do not meet any of the "high risk" categories for the free abdominal aorta screening, due to some other factors, I got that done as well (no charge).

A common "situation" of the free annual Medicare physical is that if you bring up anything - it becomes a charged visit. While that is the Kaiser medicare disclosure as well, I have often brought up new issues at my free annual physical and have never been charged :)

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Re: Do you go for annual Medicare preventive tests and screening?

Post by carolinaman » Mon Aug 20, 2018 11:48 am

I do annual wellness visit and use it to raise medical issues, some of which may be too trivial for a visit. At age 73, there are always thing to bring to my doctors attention. I also get a full panel of blood work which is something I highly recommend all seniors get.I have annual visits with specialists for PSA, breathing test (asthma) and skin checkup.

I have never had billing issues with any of this. Maybe I was just lucky about that.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Mon Aug 20, 2018 11:54 am

carolinaman wrote:
Mon Aug 20, 2018 11:48 am
I do annual wellness visit and use it to raise medical issues, some of which may be too trivial for a visit. At age 73, there are always thing to bring to my doctors attention. I also get a full panel of blood work which is something I highly recommend all seniors get.I have annual visits with specialists for PSA, breathing test (asthma) and skin checkup.

I have never had billing issues with any of this. Maybe I was just lucky about that.
Yes - :wink:

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munemaker
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Re: Do you go for annual Medicare preventive tests and screening?

Post by munemaker » Mon Aug 20, 2018 12:02 pm

dm200 wrote:
Mon Aug 20, 2018 11:06 am

A common "situation" of the free annual Medicare physical is that if you bring up anything - it becomes a charged visit. While that is the Kaiser medicare disclosure as well, I have often brought up new issues at my free annual physical and have never been charged :)
We are on ObamaCare and the same thing there. It depends on the degree of the issues that are brought up. I just had my annual exam and discussed several minor issues with the doctor; nothing required any treatment - no charge.

My wife had an issue that required subsequent diagnostic testing. Charge! She challenged the charge but they wouldn't budge. It was only $30 so no big deal. Ironically they did not charge for the diagnostic test; billing error? No idea.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Mon Aug 20, 2018 12:25 pm

munemaker wrote:
Mon Aug 20, 2018 12:02 pm
dm200 wrote:
Mon Aug 20, 2018 11:06 am
A common "situation" of the free annual Medicare physical is that if you bring up anything - it becomes a charged visit. While that is the Kaiser medicare disclosure as well, I have often brought up new issues at my free annual physical and have never been charged :)
We are on ObamaCare and the same thing there. It depends on the degree of the issues that are brought up. I just had my annual exam and discussed several minor issues with the doctor; nothing required any treatment - no charge.
My wife had an issue that required subsequent diagnostic testing. Charge! She challenged the charge but they wouldn't budge. It was only $30 so no big deal. Ironically they did not charge for the diagnostic test; billing error? No idea.
The letter of the "rules" seem clear that new issues will result in a charge. I suppose that it may depend on whether it is a "new" issue" and/or how the doctor "codes" the visit. One time, I received a bill for the copay - probably because it looked like new issue - but I received the updated pneumonia vaccine. I called the billing office - and it was quickly changed to no bill.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by Nowizard » Mon Aug 20, 2018 12:32 pm

My issue was that my doc did an EKG and chest X-ray, along with a lab test he routinely does with a physical. Medicare and my supplemental would not cover them since those items were not part of the annual, Medicare protocol being completed at the same time. These items have been covered previously when done since they are follow-ups to diagnostic conditions. I had to pay the billings for the EKG, Chest-X-ray and lab test. So, be certain that any additional tests not included with the Medicare physical are performed during another consultation with your physician.

Tim

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Re: Do you go for annual Medicare preventive tests and screening?

Post by kaneohe » Mon Aug 20, 2018 1:09 pm

Nowizard wrote:
Mon Aug 20, 2018 12:32 pm
My issue was that my doc did an EKG and chest X-ray, along with a lab test he routinely does with a physical. Medicare and my supplemental would not cover them since those items were not part of the annual, Medicare protocol being completed at the same time. These items have been covered previously when done since they are follow-ups to diagnostic conditions. I had to pay the billings for the EKG, Chest-X-ray and lab test. So, be certain that any additional tests not included with the Medicare physical are performed during another consultation with your physician.

Tim
couldn't the doc have coded this as both a wellness visit AND a physical.........if you came back for another office visit and it was coded "properly" it would have been covered. Seems to be the same thing except you made 2 trips.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by Sheepdog » Mon Aug 20, 2018 1:18 pm

Annual physical or special Medicare test? No, per se. I visit my primary care physician every 3 or 4 months. He checks me out and asks questions. I ask questions too. He orders lab tests for the next scheduled visit 2 or 3 times a year. He does not believe in asking for xrays or similar testing unless there may be an under lining problem, nor do I.

I also visit a cardiologist twice a year for his preventative tests.
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Re: Do you go for annual Medicare preventive tests and screening?

Post by likegarden » Mon Aug 20, 2018 2:21 pm

mouses,
I also noticed a change in the medication to take for a colonoscopy, but had no problems with it. I am 78 and doctor found again 2 polyps; probably have that test every 4 years. A friend is 90 and no longer will have colonoscopies, doctor found several polyps during annual tests.

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FrugalInvestor
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Re: Do you go for annual Medicare preventive tests and screening?

Post by FrugalInvestor » Mon Aug 20, 2018 2:27 pm

Here's an article that provides some insight into the coding issues that physicians deal with....

https://www.aafp.org/fpm/2012/0700/p12.html

Here's a preview of what's discussed in the article.....
No matter what your level of comfort (or discomfort) with coding preventive visits, we hope to offer information you’ll find useful. We will define the documentation components necessary to code preventive visits for patients 18 to 64 years old, review the appropriate ICD-9 and CPT codes and how to properly pair them, and discuss the proper use of modifier 25.
It's all as clear as mud to me but certainly motivates me to be more patient in dealing with coding confusion and mistakes. In my experience things have been smoothing out a bit over the last couple of years.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

Nowizard
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Re: Do you go for annual Medicare preventive tests and screening?

Post by Nowizard » Mon Aug 20, 2018 4:27 pm

Kaneohe: The doc discussed the coding issue and coded it as a physical and follow-up. Still was not accepted.

Tim

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Re: Do you go for annual Medicare preventive tests and screening?

Post by Toons » Mon Aug 20, 2018 4:48 pm

Yes I Do.
:happy
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Re: Do you go for annual Medicare preventive tests and screening?

Post by kaneohe » Mon Aug 20, 2018 6:06 pm

Nowizard wrote:
Mon Aug 20, 2018 4:27 pm
Kaneohe: The doc discussed the coding issue and coded it as a physical and follow-up. Still was not accepted.

Tim
I don't know enough to help you but why not discuss it with the experts.....is that the billing dept....and then let them fight with Medicare. If they agree that Medicare should pay , then they should want to fight to get paid.....would not dismiss a coding error.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by Sagefemme » Mon Aug 20, 2018 8:12 pm

I'm a heath care provider (not on Medicare myself yet). This thread is so depressing to me. If posters on this forum, who are generally smart, informed, and practical, have trouble deciphering these convoluted and Byzantine Medicare rules, imagine what less capable people go through?? Also, it's a perfect example of "cookie cutter" medicine--the idea that all patients of a certain age need exactly the same tests and screenings. No individualization allowed, or it will cost you!! Equally frustrating for the patient and the doctor. Sad state of affairs.

kaneohe
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Re: Do you go for annual Medicare preventive tests and screening?

Post by kaneohe » Tue Aug 21, 2018 6:51 am

In self-defense, my large medical clinic has resorted to having you (when you check in at the desk for your wellness visit ) sign an agreement that only the specific items allowed will be discussed or you may be liable for extra costs.
Must be a fairly common problem.

Lynette
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Re: Do you go for annual Medicare preventive tests and screening?

Post by Lynette » Tue Aug 21, 2018 7:08 am

I've decided not to go for a wellness test this year because of all the problems I faced last year with the Medicare Wellness Test billing and I'm too busy leveling my garden. My doctor has a small practice with about three doctors. When I tried to sort out the billing issue last year, the billing clerk asked for me to leave a message and did not return my call. There were two errors:

1. The doctor did not give me all of the required tests for the initial Welcome to Medicare

2. I was coded as someone who had been on Medicare for years because of my age - 73 at the time.

I had no problems while employed. I went to my PCP for the mandatory annual wellness test. If needed, he referred me for tests or to a specialist. I don't want to change doctors and go to a larger practice simply because they might have more experience billing specialists. I fought three rounds of sending extensive documentation to Medicare's appeals board as I was irritated but I lost. They even had my doctor's office give details of my test. In the end I was not billed.

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 9:42 am

Sagefemme wrote:
Mon Aug 20, 2018 8:12 pm
I'm a heath care provider (not on Medicare myself yet). This thread is so depressing to me. If posters on this forum, who are generally smart, informed, and practical, have trouble deciphering these convoluted and Byzantine Medicare rules, imagine what less capable people go through?? Also, it's a perfect example of "cookie cutter" medicine--the idea that all patients of a certain age need exactly the same tests and screenings. No individualization allowed, or it will cost you!! Equally frustrating for the patient and the doctor. Sad state of affairs.
Yes! I think the Medicare folks think that printing everything in LARGE TYPE solves all the problems.

However, I do think (if patient and provider get creative - within the rules) that a degree of individualization can often be accomplished.

invst65
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Re: Do you go for annual Medicare preventive tests and screening?

Post by invst65 » Tue Aug 21, 2018 10:47 am

I don't go for any preventive tests or screening at all. The last time I did was when I got talked into my first colonoscopy when I turned 60 (10 years overdue according to the doctor). I ended up having to pay for it out of pocket and fight for reimbursement because the wrong billing codes were entered. When the doctor said there were no problems and "I'll see you in 10 years", I thought to myself "no you won't".

I don't even have a primary care physician nowadays because they have all fired me as a patient. When I get sick I go to an urgent care facility.

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 10:58 am

When I went on Medicare in 2011, I immediately chose the Kaiser Medicare plan. I have/had several conditions that require regular specialist test/reviews - so I scheduled an apt with my PCP. It was a charged visit - but the copay was only $20. I got the 2-3 specialist referrals I needed and got to meet my new PCP. Then, I scheduled the no-charge annual Medicare physical/health assessment 3 months later to review and do a few more things. All went very well. I don't know how Kaiser is compensated for this, but about half of what I do with my PCP (and some specialists) I do by email or telephone appts (There is no charge to me for either).

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Re: Do you go for annual Medicare preventive tests and screening?

Post by drawpoker » Tue Aug 21, 2018 11:36 am

dm200 wrote:
Tue Aug 21, 2018 10:58 am
.... but about half of what I do with my PCP (and some specialists) I do by email or telephone appts (There is no charge to me for either).
There is no charge to anyone, as those are not "appointments". By law, doctors cannot bill Medicare for patient appointments that are not face-to-face.

We already covered this in another recent thread. Providers did receive some small financial compensation for going into full compliance with the federal electronic records requirements of 2015 law. (But, according to my doctor, that money ran out early last year)

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 12:05 pm

invst65 wrote:
Tue Aug 21, 2018 10:47 am
I don't go for any preventive tests or screening at all. The last time I did was when I got talked into my first colonoscopy when I turned 60 (10 years overdue according to the doctor). I ended up having to pay for it out of pocket and fight for reimbursement because the wrong billing codes were entered. When the doctor said there were no problems and "I'll see you in 10 years", I thought to myself "no you won't".
I don't even have a primary care physician nowadays because they have all fired me as a patient. When I get sick I go to an urgent care facility.
Wow! Especially since I am older now, I regard access to healthcare as very important. While I also believe that screenings/tests are often overdone, some save lives. While I might disagree with a Physician about something, I never want any provider to consider me any type of "problem" or "difficult" patient..

My current (for seven years) PCP seems to often go out of her way to provide very prompt response to my conditions and concerns - well beyond "normal". For example, I scheduled (online) a late Friday afternoon apt with her late on the day before (Thursday) and I put a note that I had abdominal pain. She saw it and tried to call me before she left the office on Thursday - but did not get me on my cell phone. She then called me first thing Friday morning and said that this late Friday appointment would be after the lab closed and she wanted me to come in early in the afternoon - so she could order some lab tests. I saw her at about 2 pm - and got the blood tests. The results were not back when she left the office, BUT checked online after she got home and told me (by email) that she wanted more tests the next week, but the initial tests did not indicate anything serious.

invst65
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Re: Do you go for annual Medicare preventive tests and screening?

Post by invst65 » Tue Aug 21, 2018 1:21 pm

dm200 wrote:
Tue Aug 21, 2018 12:05 pm
invst65 wrote:
Tue Aug 21, 2018 10:47 am
I don't go for any preventive tests or screening at all. The last time I did was when I got talked into my first colonoscopy when I turned 60 (10 years overdue according to the doctor). I ended up having to pay for it out of pocket and fight for reimbursement because the wrong billing codes were entered. When the doctor said there were no problems and "I'll see you in 10 years", I thought to myself "no you won't".
I don't even have a primary care physician nowadays because they have all fired me as a patient. When I get sick I go to an urgent care facility.
Wow! Especially since I am older now, I regard access to healthcare as very important. While I also believe that screenings/tests are often overdone, some save lives. While I might disagree with a Physician about something, I never want any provider to consider me any type of "problem" or "difficult" patient..

My current (for seven years) PCP seems to often go out of her way to provide very prompt response to my conditions and concerns - well beyond "normal". For example, I scheduled (online) a late Friday afternoon apt with her late on the day before (Thursday) and I put a note that I had abdominal pain. She saw it and tried to call me before she left the office on Thursday - but did not get me on my cell phone. She then called me first thing Friday morning and said that this late Friday appointment would be after the lab closed and she wanted me to come in early in the afternoon - so she could order some lab tests. I saw her at about 2 pm - and got the blood tests. The results were not back when she left the office, BUT checked online after she got home and told me (by email) that she wanted more tests the next week, but the initial tests did not indicate anything serious.
Congratulations on finding a good PCP. The last time I engaged one I also had abdominal pain as well as a bad case of vertigo so I thought there might be something seriously wrong and made an appointment with the only one who would see me right away (others couldn't see me for weeks or even months). She referred me to specialists for thousands of dollars worth of tests which found nothing and I eventually got better on my own (a typical story for me). As for the PCP, however, she ordered some blood tests and had me return for a follow up exam. Predictably, she found I had high cholesterol and wanted to put me on a Statin drug. Since not wanting to take a statin was the reason I got fired from my last PCP I figured maybe I'd better go ahead and do what she wanted. Instead of prescribing one of the lower priced generic statins however, she put me on the newest and most expensive one. I later found out from a website that she received compensation from the drug company. She also wanted me to go for another blood test and return for a visit every 3 months which I thought was kind of strange since the current recommendation seems to be to only do it once a year. When she scheduled appointments at 8:00 AM and didn't show up in the office until 10:00 on two occasions I decided I'd had enough and fired her before she had a chance to fire me.

The strangest thing of all however, was that at no time in all of my return visits did she ever ask me anything or even mention the original complaint that prompted me to visit her.

Call me cynical in my old age if you want (I admit it) but it appeared to me that this doctor's primary concern was in mining my blood test for medicines to prescribe and future office visits to schedule.

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 2:57 pm

invst65 wrote:
Tue Aug 21, 2018 1:21 pm
dm200 wrote:
Tue Aug 21, 2018 12:05 pm
invst65 wrote:
Tue Aug 21, 2018 10:47 am
I don't go for any preventive tests or screening at all. The last time I did was when I got talked into my first colonoscopy when I turned 60 (10 years overdue according to the doctor). I ended up having to pay for it out of pocket and fight for reimbursement because the wrong billing codes were entered. When the doctor said there were no problems and "I'll see you in 10 years", I thought to myself "no you won't".
I don't even have a primary care physician nowadays because they have all fired me as a patient. When I get sick I go to an urgent care facility.
Wow! Especially since I am older now, I regard access to healthcare as very important. While I also believe that screenings/tests are often overdone, some save lives. While I might disagree with a Physician about something, I never want any provider to consider me any type of "problem" or "difficult" patient..
My current (for seven years) PCP seems to often go out of her way to provide very prompt response to my conditions and concerns - well beyond "normal". For example, I scheduled (online) a late Friday afternoon apt with her late on the day before (Thursday) and I put a note that I had abdominal pain. She saw it and tried to call me before she left the office on Thursday - but did not get me on my cell phone. She then called me first thing Friday morning and said that this late Friday appointment would be after the lab closed and she wanted me to come in early in the afternoon - so she could order some lab tests. I saw her at about 2 pm - and got the blood tests. The results were not back when she left the office, BUT checked online after she got home and told me (by email) that she wanted more tests the next week, but the initial tests did not indicate anything serious.
Congratulations on finding a good PCP. The last time I engaged one I also had abdominal pain as well as a bad case of vertigo so I thought there might be something seriously wrong and made an appointment with the only one who would see me right away (others couldn't see me for weeks or even months). She referred me to specialists for thousands of dollars worth of tests which found nothing and I eventually got better on my own (a typical story for me). As for the PCP, however, she ordered some blood tests and had me return for a follow up exam. Predictably, she found I had high cholesterol and wanted to put me on a Statin drug. Since not wanting to take a statin was the reason I got fired from my last PCP I figured maybe I'd better go ahead and do what she wanted. Instead of prescribing one of the lower priced generic statins however, she put me on the newest and most expensive one. I later found out from a website that she received compensation from the drug company. She also wanted me to go for another blood test and return for a visit every 3 months which I thought was kind of strange since the current recommendation seems to be to only do it once a year. When she scheduled appointments at 8:00 AM and didn't show up in the office until 10:00 on two occasions I decided I'd had enough and fired her before she had a chance to fire me.

The strangest thing of all however, was that at no time in all of my return visits did she ever ask me anything or even mention the original complaint that prompted me to visit her.

Call me cynical in my old age if you want (I admit it) but it appeared to me that this doctor's primary concern was in mining my blood test for medicines to prescribe and future office visits to schedule.
Last year, my PCP had a warning pop up on her computer when I had my annual health assessment that (according to some magic formula) I had about a 20% probability of having heart attack - and she wanted me to go on statins. Even had the prescription ready at the pharmacy. I "pushed back" that this "magic formula" did not take into account the many positive lifestyle changes I had made and I cited (by email with her) an extensive study to that effect. She has not brought it up again - and we get along just fine!

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Re: Do you go for annual Medicare preventive tests and screening?

Post by retiredjg » Tue Aug 21, 2018 3:07 pm

invst65 wrote:
Tue Aug 21, 2018 1:21 pm
Since not wanting to take a statin was the reason I got fired from my last PCP...
The idea that a physician would fire a patient over not wanting to take a drug is incomprehensible to me. Surely this is not common....

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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 4:06 pm

retiredjg wrote:
Tue Aug 21, 2018 3:07 pm
invst65 wrote:
Tue Aug 21, 2018 1:21 pm
Since not wanting to take a statin was the reason I got fired from my last PCP...
The idea that a physician would fire a patient over not wanting to take a drug is incomprehensible to me. Surely this is not common....
I have never been "fired" by any Physician - or even threatened with it. I do not know the details, but an acquaintance of mine recently told me he now sees the same PCP as I do, having been "fired" by his previous Kaiser PCP.

Maybe it is not WHAT you do or do not do, but rather how you communicate with the Physician?

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 4:39 pm

retiredjg wrote:
Tue Aug 21, 2018 3:07 pm
invst65 wrote:
Tue Aug 21, 2018 1:21 pm
Since not wanting to take a statin was the reason I got fired from my last PCP...
The idea that a physician would fire a patient over not wanting to take a drug is incomprehensible to me. Surely this is not common....
Right.. I suspect there is more to the full story!

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Re: Do you go for annual Medicare preventive tests and screening?

Post by jebmke » Tue Aug 21, 2018 5:02 pm

My PCP and I have an agreement. Physical every other year. Labs every five years unless there is some reason to run them.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: Do you go for annual Medicare preventive tests and screening?

Post by jebmke » Tue Aug 21, 2018 5:04 pm

dm200 wrote:
Tue Aug 21, 2018 4:39 pm
retiredjg wrote:
Tue Aug 21, 2018 3:07 pm
invst65 wrote:
Tue Aug 21, 2018 1:21 pm
Since not wanting to take a statin was the reason I got fired from my last PCP...
The idea that a physician would fire a patient over not wanting to take a drug is incomprehensible to me. Surely this is not common....
Right.. I suspect there is more to the full story!
A neighbor of a friend was fired by a cardio for refusing to take one of the newer blood thinners (instead of a generic) that has had some disastrous (fatal) side effects. We suspect the cardio is one of the ones who get payments from the pharma.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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dm200
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Re: Do you go for annual Medicare preventive tests and screening?

Post by dm200 » Tue Aug 21, 2018 5:16 pm

While this is, to a degree, anecdotal - more tests are not always harmless - https://nutritionfacts.org/video/is-it- ... ical-exam/

This Cleveland Clinic doc shared a story about his own father, who went in for a “checkup.” Can’t hurt, right? The doctor thought he felt what might have been an “aortic aneurism;” so, he “ordered an abdominal ultrasound.” Can’t hurt, right? Aorta was fine, but hmm, something looked “suspicious” on his pancreas; so, “a CT scan” was ordered. That can hurt: lots of radiation. But thankfully, his pancreas looked fine. But hey—what’s that on his liver? Oh, for goodness sake. Looked like cancer, which made a certain amount of sense, having worked in the chemical industry. So, realizing how ineffective the treatments were for liver cancer, he realized he was going to die.

The daughter was not ready to give up on him, though; “convinced him to see a specialist.” Maybe, if they could cut it out, he could live at least a few more years. But first, they had to do a biopsy. And, the good news was, no cancer. The bad news, though, it was a benign mass of blood vessels; and so, when they stuck a needle in it, “he almost bled to death.” Ten units of blood is like all you have. Pain, and so morphine, and so urinary retention, and so catheter; yet, thankfully, no infection. Just a bill for $50,000.

“The frustrating thing” is that the whole horrible sequence wasn’t like malpractice or anything; every step logically led to the next. “The only way to have prevented this [life-threatening] outcome would have been to dispense with [that] initial physical exam”—the one that couldn’t hurt, right?

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