Templates for Medicare Wellness Visits, CANS-MCI for Cognitive Impairment

January 21st, 2011

This one is going to be a long one; but it's important to your bottom line, so please take a minute to read.

Several of our primary care clients have told us that the reporting requirements for the Medicare wellness exams are so extensive they would probably elect not to do the exams. 

To try to encourage our clients to conduct the exams, KLA has developed a Medicare Wellness Visit template (in Word format) that can be used for all your Medicare Wellness Visits from IPPE (Welcome to Medicare) to Subsequent Annual Wellness Visit.

For every primary care client for which we've run the numbers, performing the Medicare Wellness visits can mean $50,000 or more in annual income.  Some of our clients would have in excess of $100,000 in additional income based on the number of Medicare patients seen by a single physician.  PLUS, these visits are not subject to cost sharing, ie deductible or co-pays.  By scheduling them early in the year, a practice can minimize the impact of the annual Medicare deductible on its cash flow.

Today, Family Practice Management issued a good digital article on the IPPE and Annual Wellness Visit.  This article explains why, if you are a primary care provider, you NEED TO offer these services.  The article includes another template for the Medicare Prevent Physical Exam.  You may prefer it to the one KLA put together.  It includes elements that the KLA template assumes are maintained elsewhere in your patient file such as history, allergy and medication lists.

For the official word from Medicare, visit:  http://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf.

In the KLA template, there are two items that may need further explanation.

The first is a reference to Caring Connections under Advance Planning. We blogged about this site a few weeks ago.  In a nutshell, it's a site that offers free, downloadable, state-specific advance planning directives. 

The second is a reference to CANS-MCI under Cognitive Assessment.  I borrowed the following (with permission of course) from reimbursement Guru Don Self's recent newsletter:

"...the fourth measure of the new annual Medicare exams is “Detect any Cognitive Impairment”. The Medicare program does not dictate to you HOW you detect it, but only that you do so.

There is a simple—yet very effective—method of Cognitive testing, that requires almost no staff time to accomplish, and takes away the “guesswork” that an MMSE involves. This Cognitive Testing is testing for memory, attention, response speed & processing speed and requires an average of 25 to 40 minutes of the patient’s time in your own office. This is so much easier on the patient than sending them across town, and it is very profitable for our clients.

We (Don Self) recommend and sell the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI®). This test was developed as an instrument for detection of mild cognitive impairment, that is not only self-administered (by the patient), but also is touch screen driven to practically eliminate you or your staff having to sit with the patient while they take the test.  It is common knowledge that the earlier you detect the chronic disease process, the better chance you have of making a difference in the progression of the disease.  Neuropsychological or imaging evaluations early enough in the pre-clinical phase of the disease enhance the effectiveness of treatments.

It is possible for you to provide this service to your patients and get the point-of-care information to make medical decisions, without having a capital outlay. One tool we have added to our arsenal in helping physicians is the CANS-MCI test and it does not require any capital investment. Medicare (as well as CIGNA, UHC, BCBS and every other carrier we have reviewed) pays for the following codes when done in a physician office, which is part of the CANS-MCI test:

96103: Psychological testing admin. by computer $57.44

96120: Neuro-psych test administered with computer $89.43

The average Medicare allowed in the country are shown, so this means that Medicare’s allowed in your area will be about $146.87."

If you want to learn more about CANS-MCI, please contact Don directly at:  donself [at] donself [dot] com.

By 2015, Medicare is scheduled to transition to a patient managed rather than fee-for-service model.  By keeping up each step of the way, your practice will be ready for the transition.

Please share this information with other primary care providers.  Together, each one of us is stronger.

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