Medicare Part B Coverage of Preventive Exams - New Rules for 2011

As part of the Patient Protection and Affordable Care Act, Medicare Part B coverage for preventive exams will change. Starting on January 1, 2011, Medicare will cover an annual preventive examination. The Initial Preventive Physical Examination service will remain and be available as a service those beneficiaries within the first 12 months of coverage under Part B. The coinsurance/deductible will not apply to the new preventive services. 

That preventive exam will need to include a health risk assessment, an update to the patient’s medical and family history, a list of providers and suppliers involved in the patient’s care, including a list of all prescribed medications. The Act also requires measurements of height, weight, BMI (or waist circumference), blood pressure and other routine measurements. Also part of the preventive exam is the establishment of or an update to a screening schedule for the next 5-10 years, based on recommendations of the United States Preventive Services Task Force (USPSTF) and Advisory Committee on Immunization Practices.

From their website http://www.ahrq.gov/clinic/uspstfix.htm : The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements." The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against).”

Within a year of this rule, the Secretary of the Department of Health and Human Services must establish publically available guidelines for health risk assessments. The rule also allows the Secretary to adjust coverage for preventive services based on USPSTF recommendations. Services that are recommended with a grade of A or B by the USPSTF will be implemented by the Affordable Care Act. A list of these services may be found here: http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm

Written by Kathy Lindstrom, RHIT