Prestige Medical Consultants

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Medicare Covers Obesity Screening

CMS Coverage of Obesity Screening

by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC– December 21, 2011 at 2:32 pm

On November 29, 2011, a final coverage decision memorandum was passed by the Center for Medicare and Medicaid Services (CMS) for intensive behavioral therapy for obesity. These services have been deemed reasonable and necessary for the prevention or early detection of illness and/or disability and are appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

CMS specified in the decision memo that it will cover:

  • One face-to-face visit every week for the first month in the primary care setting;
  • One face-to-face visit every other week for months 2-6;
  • One face-to-face visit every month for months 7-12, if the Medicare beneficiary meets the 3kg (6.7 lbs) weight loss requirement.

At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, Medicare beneficiaries must have achieved a reduction in weight of at least 3kg (6.7 lbs) over the course of the first six months of intensive therapy. This determination must be documented in the physician office medical records for applicable Medicare beneficiaries consistent with usual practice. For Medicare beneficiaries who do not achieve a weight loss of at least 3kg (6.7 lbs) during the first six months of intensive therapy, a re-assessment of their readiness to change and Body Mass Index (BMI) is appropriate after an additional six month period.

The memo defined intensive behavioral therapy for obesity as consisting of

  • Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (kg/m2)
  • A dietary (nutritional) assessment; and
  • Intensive behavioral counseling and behavioral therapy that promotes sustained weight loss through high-intensity interventions on diet and exercise.

According to CMS, all such interventions should be consistent with the 5-A framework highlighted by the U.S. Preventive Services Task Force (USPSTF), which include:

  • Assessing:Asking about/assessing behavioral health risks and factors affecting choice of behavior change goals/methods.
  • Advising:Giving clear, specific and personalized behavior change advice, including information about personal health harms and benefits.
  • Agreeing:Collaboratively agreeing on appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  • Assisting:Using behavior change techniques (e.g., self-help and/or counseling) to assist the patient to achieve agreed-upon goals by acquiring the skills, confidence and social/environmental supports for behavior change, supplemented with adjunctive medical treatments, when appropriate.
  • Arranging:Scheduling follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

For the purposes of this decision memorandum, a primary care setting is defined as:

  • There is provision of integrated accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients; and
  • Practicing in the context of family and community.

Note:Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.

While this benefit is limited to primary care practitioners and primary care settings, it does not preclude primary care practitioners from screening beneficiaries for obesity and referring those who screen positive with a BMI ≥ 30 kg/m2 to other practitioners and/or settings for intensive multicomponent counseling; however coverage remains only in the primary care setting.

The following is a link for more information on this CMS program memorandum.

MBA announces the start of our Private Charity Foundation

Medical Billing Alternatives is proud to announce the start of our Private Foundation,  C & M Anderson Charity Foundation.  The purpose of this foundation is to provide financial assistance in order to ease the burden of higher education, traumatic disasters, and to promote a new beginning for young people and disaster ridden individuals in Middle Tennessee.

The first Scholarship we will offer will be called the Mary Duncan Scholarship and it will be given annually to a graduating, registered Girl Scout in Middle Tennesee who has earned her Gold Award and maintains a GPA of 3.8 or better.

Please click on the attached document to download our Mary Duncan Scholarship application.

Stay tuned, we will be adding additional assistance applications and scholarship applications in the future.

Free EHR Software, Free Billing Software and…

Best of all – YOU GET PAID instead of you having to pay for it.

EHR – You can qualify for up to $44,000 in incentives through the HITECH Act  for using a qualified EHR system.  Practice Fusion is a completely free EHR available to all physicians.  Check them out at www. Practicefusion.com.  The other great thing about Practice Fusion is that they have joined forces with Collaborate MD (the software we use) and the interface between the two systems is being done at no charge.

It’s Deductible Time!

Make sure you don’t let your cash flow decrease during this time of the year.  Verify how much the patient owes towards their deductible and collect it at the time of service.Deductible verification can be done on our software at no cost to you.  So don’t let those easily collected dollars slip through your hands.

AMA: Congress Passes One-Year Delay Of Medicare Physician Cut

This was recently posted on AMA’s website:

“The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year. Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011.  Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat.

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