Medicare Policies
To all our Medicare Patients:
The Medicare policies are changing regularly due to the new federal government healthcare laws. While these changes are intended to improve the quality of your care and access to such care, you will have to do thing differently than you have done so in the past.
1. Effective July 1, 2010, you as a Medicare patient must provide us with the name and the National Physician Identifcation (NPI) number for your primary care physician (PCP). This is to ensure that your PCP is a legitimate physician and currently enrolled in the Medicare program. You can call us at any time to provide this information to us, but we will need it prior to your next appointment.
2. There will be changed in what Medicare provides in terms of preventative services that will become effective on January 1, 2011. New regulations are being written at this time with regard to this topic. In the meantime, until then, Medicare does not cover preventative services. When you are seen for your Annual Exam, the following services are provided:
- Office Visit - $146.52 this charge includes our staff checking your weight, and blood pressure, as well as the doctor discussing any health concerns or changes in your overall health. Dispensing maintenance prescriptions and refills are also a part of the office charge.
- Collection of Pap smear - $46.54 (There is a separate lab charge for processing of specimen - this is billed by the lab)
- Breast Exam - $40.78
- Hemoccult - $15.00
- Urine Dip - $8.00
Though the breast exam and papsmear will be covered every 24 months (two years), the office visit charge that is assessed when you are seen will never be paid by Medicare. The hemoccult is covered every 12 months (one year).
You may choose to see your Primary Care Physician for your routine annual exam and your Gynecologist for all other female issues, or you may choose to see your Gynecologist for the annual exam. Please be aware that when you choose to see a specialist (your Gynecologist) for your annual well-woman exam, the office visit charge will not be paid by Medicare. The fee for that service, $146.52, will be your responsibility. Should you be seen for services that are not routine, such as an acute problem, at the same time that your annual breast exam and papsmear are done, the office visit will be billed to Medicare and may be covered. The breast exam and papsmear may or may not be covered depending on whether or not it has been 12 or 24 months since your last breast exam and Pap smear. It is your (the patient’s) responsibility to keep track of what year Medicare last covered those services. We will be happy to bill for those charges and wait for Medicare’s reply. You will be billed for any services that Medicare does not cover.
Should you have any questions regarding Medicare’s payment policies for preventative services, please contact Medicare. If needed, we would be happy to explain this policy to you at your next appointment.
Thank you.
Type of visit |
How often? |
Covered by
|
What is the cost to ME? |
|
Routine well-woman annual Exam |
…with your Primary Care Physician | Once per year | Yes | $0 |
| OR …with your specialist (Gynecologist) |
Any time | No | $146.52 | |
| OR …if you go to your specialist, but also have an immediate problem |
Once per year | Yes | $0 | |
Pap Smear |
Annual or General office visit |
Once every two years | Yes | $0 |
| More than once every two years | No | $46.54 (There is also a separate lab charge for processing of specimen which is billed by the lab) | ||
Breast Exam |
Annual or General office visit |
Once every two years | Yes | $0 |
| More than once every two years/td> | No | $40.78 | ||
Hemoccult |
Annual or General office visit |
Once per year | Yes | $0 |
| More than once per year | No | $15.00 | ||
| Urine Dip | Annual or General office visit | Any time | No | $8.00 |
| Acute Problem (injury, etc.) | Annual or General office visit office visit | Any time | Maybe | Determined by Medicare |