Medicare Changes Coming for 2011
There are several changes in Medicare, which are required by the Healthcare Reform Bill, which took effect on January 1, 2011. These changes largely affect the amount paid by Medicare for Medicare participants for drugs and doctors’ services. Here is a brief recap of the changes which occurred on January 1, 2011:
- Free annual wellness check-up for all Medicare Part B participants. Previously, Medicare Part B participants were allowed the wellness check-up only on enrollment and this exam is subject to deductible regulations.
- No ‘out-of-pocket’ expenses for specified preventative exams for Medicare Part B participants.
- Closing of the ‘donut hole’ medication gap. Requires manufacturers of brand name drugs to reduce the cost of covered drugs by 50% in 2011, increasing the deduction to 75% by 2020. Generic drug cost will be reduced in the Medicare Part D drug coverage from 7% in 2011 to 75% by 2020.
- There will be premium surcharges for wealthy Medicare Part D participants, which will be gradually increased over the next few years.
- The limit on income, on which participants pay a surcharge for Part B (and Part D in 2012), will not be indexed to inflation through 2019. As incomes rise due to inflation, more seniors will be subject to the surcharge.
What do these changes mean to the doctor providing services for Medicare Recipients?
The change to an annual check-up paid for by Medicare, will allow the doctor to catch some health problems earlier, and provide treatment earlier, hopefully to decrease overall cost of the treatment. Your office should make sure that all of your Medicare Part B patients take advantage of this new provision.
The preventative screenings now covered by Medicare Part B participants are:
Colorectal Exam Pelvic exam and Pap smear
Mammograms Bone Density tests
Prostate exam Diabetes screenings as needed
Some of these tests will be covered on an annual basis, and some as indicated by other physical findings. For a complete guide on which services are covered, and when; you can receive a copy of the new guidelines from:
The changes in the price structure for brand name drugs and generic drugs, will allow the treating doctor more flexibility in prescribing drugs, without having to be excessively cost conscious. This change should allow the doctor to treat the patient as the doctor deems necessary, prescribing the proper drug and feeling more confident that the patient will be able to follow through and purchase and take the required drugs.
2011 Physician’s Medicare fee schedule
Several changes in the fee schedules for 2011 are aimed at enticing more doctors into the primary care area of practice. The 2011 physician fee schedule provides a 10% incentive payment for doctors to provide primary care services. Family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists and physician assistants who derive at least 60% of their income from Medicare physician fee schedule-allowed charges are eligible for the payment. Changes were also made that will, reportedly, enable 80% of general family practitioners to qualify for the incentive; up from 60% as previously proposed.
On the flip side- The rule calls for Medicare physician payments to be slashed by 25% - 23% on Dec. 1, 2010 and 2% on Jan. 1, 2011. These payment cuts could be avoided if Congress intervenes. No further updates have been released to date.
There is an incentive provision aimed at enticing surgeon’s to move to underserved communities. To be eligible for the 10% incentive, the physician must be enrolled in the Medicare program as a general surgeon and practice in a ZIP code in a CMS-designated professional area of shortage.
All of these changes may be revised or repealed with the new congress. Funding for any Medicare programs must be provided through spending bills, all of which must originate in the House of Representatives. The funding for 2011 is very likely to be provided, but in the elections of November, 2010, the American public sent a clear message to Congress that spending and government regulations must be curtailed. It will be very interesting to see exactly what unfolds in Congress over the coming years.
What steps are necessary to qualify forthe 10% incentatives?
dr. harold holloway
I’ve looked for the CPT code to use for the Medicare free annual checkup and have not been able to find one. Is there a CPT code or do we just use a ICD-9 code, AND if so what is the ICD-9 code?
What steps are necessary to qualify for the 10% incentatives and also what code is used for the Medicare free annual checkup, please help?
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