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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Medicare Provides Coverage for Many Preventive Services and Screenings
Note: This article was revised on June 30, 2006 to remove references to the “Flu Billing” videos, which are no longer available on the CMS Web site. |
Provider Types Affected
All Medicare fee-for-service physicians, providers, suppliers, and other health care professionals who provide and bill for preventive services and screenings provided to Medicare beneficiaries
Provider Action Needed
This article serves as a reminder that we need your help to ensure that Medicare beneficiaries receive the preventive services they need. Become familiar with the preventive services and screenings covered by Medicare. Help the Centers for Medicare & Medicaid Services (CMS) spread the news about the many preventive services and screenings covered by Medicare.
Talk with your Medicare patients about preventive services and screenings and encourage use of those services, where appropriate. Order and use the educational products developed by CMS to educate your staff about these benefits. The information found in these products will also help you communicate with your patients about Medicare preventive benefits.
Introduction
Medicare provides coverage for many diseases that are preventable through immunization or amendable through early detection, treatment, and lifestyle changes. This Special Edition MLN Matters article informs health care professionals about the preventive services and screenings covered by Medicare and highlights the educational and informational products developed by CMS for health care professionals to promote awareness and increase appropriate utilization of these services.
Medicare provides coverage for the following preventive services and screenings (subject to certain eligibility and other limitations):
- Adult Immunizations
- Influenza (Flu)
- Pneumococcal Polysaccharide Vaccine (PPV)
- Hepatitis B Virus (HBV)
- Bone Mass Measurements
- Cancer Screenings
- Breast (Mammography)
- Cervical & Vaginal (Pap Test & Pelvic Exam)
- Colorectal
- Prostate
- Cardiovascular Disease Screening
- Diabetes Screening, and Self-Management Training
- Medical Nutrition Therapy
- Supplies
- Glaucoma Screening
- Initial Preventive Physical Exam (IPPE)
- Smoking and Tobacco-Use Cessation Counseling Services
CMS needs your help to get the word out about the many preventive services and screenings covered by Medicare. Each of these benefits presents an opportunity for health care professionals to help Medicare beneficiaries learn if they have an increased risk of developing certain diseases.
CMS recognizes the crucial role that health care professionals play in promoting, providing, and educating Medicare patients about preventive services and screenings. As a trusted source, your recommendation is the most important factor in increasing the use of appropriate preventive services.
Talk to your Medicare patients about the benefits of preventive medicine, detecting disease earlier when outcomes are best, reducing infectious disease, and improving the quality of their lives.
Educational Products and Informational Resources for Health Care Professionals
CMS has developed a variety of educational products to:
- Help increase your awareness of Medicare’s coverage of disease prevention and early detection;
- Provide you with information and tools to help you communicate with your Medicare patients about these potentially life-saving benefits for which they may be eligible; and
- Give you resources to help you effectively file claims.
Print products may be ordered, free-of-charge, from the Medicare Learning Network (MLN). All print products are available to download and view online and may be reprinted or redistributed as needed. Some print products are only available as a download and will be notated as such.
Product Ordering Instructions
To order a product, free-of-charge, click here: Order Product.
You may click on the links of the publications below to view them online. |
Brochures
The Medicare Preventive Services Brochure Series for Physicians, Providers, Suppliers, and Other Health Care Professionals - This series of tri-fold brochures provides an overview of Medicare’s coverage for preventive services and screenings including the new benefits: diabetes and cardiovascular disease screenings and the initial preventive physical examination (IPPE). (See Expanded Benefits brochure.)
Guides
The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals [PDF 2MB] - This guide provides information on Medicare’s preventive benefits including coverage, frequency, risk factors, billing and reimbursement. (May 2005; see the Errata Sheet for corrections identified since May 2005 printing.)
Determining a Medicare Beneficiary’s Eligibility for Medicare Preventive Services [PDF 304KB] - This guide provides information on interpreting the Medicare beneficiary preventive services “next eligible date” data and is intended to supplement the educational materials already available for the HIQA, HIQH, HUQA, ELGA, ELGB, and ELGH eligibility inquiry screens used to access Common Working File (CWF) records. (September 2005; Available in download only.)
Medicare Preventive Services CD-ROM
Medicare Preventive Services Resources for Physicians, Providers,
Suppliers, and Other Health Care Professionals - This CD-ROM contains The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals; six brochures: 1) Expanded Benefits, 2) Glaucoma Screenings, 3) Cancer Screenings,4) Bone Mass Measurements, 5) Adult Immunizations, and 6) Smoking and Tobacco-Use Cessation Counseling Services; and a Quick Reference Information: Medicare Preventive Services chart. These resources are useful for Medicare fee-for-service physicians, providers, suppliers, and other health care professionals that bill Medicare for preventive services. (See Errata Sheets for corrections identified since May 2005 printing of these products; See product ordering instructions above.)
Quick Reference Information Chart
Quick Reference Information: Medicare Preventive Services [PDF 74KB] - This two-sided laminated chart gives a quick reference to Medicare’s preventive services and screenings, identifying coding requirements, eligibility, frequency parameters, and copayment/coinsurance and deductible information for each benefit. (May 2005; See Errata Sheet for corrections identified since May 2005 printing.)
Web-Based Training Courses
Web-Based Training Modules (WBT) - Three Web-based training courses covering coding, billing, coverage, and reimbursement for Medicare preventive services and screenings. (To access these WBT courses, go to the MLN Products Web page at http://www.cms.hhs.gov/MLNProducts/  , scroll to the bottom of the page to “Links Inside CMS,” and click on Web-based Training Modules.
Web Page
MLN Preventive Services Web Page - This Medicare Learning Network (MLN) Web page, for Medicare fee-for-services health care professionals, provides links to all of the provider/supplier specific preventive services educational and informational products mentioned in this article.
Other Useful Provider Resources
Other useful provider resources include the following:
Prevention Toolkit - This online toolkit contains resources that you may find useful when talking to your patients about Medicare preventive benefits.
Immunizations Toolkit - This online toolkit contains printable resources that nursing home providers can use to help improve the influenza and pneumococcal immunization rates among their residents, staff, and volunteers.
CMS Prevention Web Pages
CMS has created individual Web pages for each of the preventive services and screenings covered by Medicare. For additional information, visit http://www.cms.hhs.gov/home/medicare.asp a nd scroll down to the Prevention section.
Medicare Learning Network (MLN)
The Medicare Learning Network (MLN) is the brand name for official CMS educational products and information for Medicare fee-for-service providers. For additional information visit the Medicare Learning Network’s Web page at http://www.cms.hhs.gov/MLNGenInfo on the CMS Web site.
We encourage you to order and use these provider-specific products to:
- Increase your awareness of preventive services covered by Medicare;
- Equip you to talk with your patients about Medicare-covered preventive services and encourage utilization of these potentially life saving benefits; and
- Help you file preventive services claims more effectively.
Please note: These products have been developed for you, the health care professional. Provider-specific products are not meant for distribution to Medicare beneficiaries. See below for where to obtain beneficiary specific information.
Preventive Benefit Information for Medicare Beneficiaries
Medicare beneficiaries can obtain information about Medicare preventive benefits by going to http://www.medicare.gov/ and clicking on “Preventive Services.”
They can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: SE0630 Revised
Related Change Request (CR) #: N/A
Effective Date: N/A
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