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One question has come up about social determinants of health (SDOH) assessments with the Medicare annual wellness visit: If the provider taking the assessment finds the patient has social issues that should be addressed – e.g. housing status, transportation to health care appointments – is the provider obliged to address them, or simply document them? An expert responds.

CMS said in an April 13 provider call that to bill advance care planning (ACP) without a preventive service, you need to show the service is “relevant to the patient’s disease state,” which would seem to mean it requires a diagnosis code.

CMS' new FAQs on advance care planning (ACP) contain some clarifications for which providers have been waiting, including guidance on how time should be counted and how frequently the service may be billed.

You’ve barely had time to process the new material in the 2012 Physician Fee Schedule final rule, but some of your peers are already blasting CMS for making annual wellness visits (AWVs) tougher to bill. The new component to the AWV is called the health risk assessment (HRA). Problem is, the AWV was already confusing to patients because it’s too restricting, includes no physical exam and is different from what patients and providers are used to as far as a “physical,” one angry caller told CMS during the agency’s latest open door call Nov. 7.

Get ready for an influx of new Medicare beneficiaries as the Medicare Open Enrollment Period starts. This year, the period begins earlier on Oct. 15 and will last seven weeks, through Dec. 7. A major new wrinkle this year are CMS-published star ratings for Medicare Advantage (MA) plans. “This year CMS is highlighting plans that have achieved an overall quality rating of 5 stars with a high performer or ‘gold star’ icon so people with Medicare can easily find high quality plans,” the agency said in an Oct. 12 press release.


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