These benefits must be offered in all health plans starting October of 2010
What is Wellness and Preventative benefits?
100
An expense that will be reimbursed according to the terms of the plan or insurance contract.
What is covered expense
100
It’s important to have these on file so that you can verify insurance benefits prior to your patient’s first office visit.
What are a valid insurance card and driver's license
100
Procedure that begins as this, but uncovers significant pathology, requiring attention at that time, becomes a diagnostic service
What is Screening
100
A provider can have more than one of these in order for Medicare to pay the right provider
What is a PTAN Number
200
These drugs are no longer reimbursable under HSAs, medical FSAS, HRAs and Archer MSAs unless prescribed by a doctor.
What are over the count drugs?
200
Special accounts typically funded by an employee's salary reduction to help pay certain expenses not covered by the employer's plan or insurance contract. The advantage of these accounts is that after-tax dollars are converted to before-tax dollars, thereby reducing the actual cost of expenses.
What are Flexible Spending Accounts
200
Patients with this are required by Federal law to provide current Proof of Eligibility when seeking medical care. Eligibility in these programs change quickly and benefits are not paid without adequate proof of eligibility at the time of treatment.
What is Medicare
200
Screening Risk Factors for this disease include:
Hypertension
High Cholesterol
Obesity
Previous identification of elevated impaired fasting glucose or glucose intolerance
What is Diabetes
200
For Medicare purposed these numbers are related to each other
What is The NPI and the PTAN
300
In 2014 Employers may give these to employees who participate in a wellness program and meet certain health related standards
What are employee rewards of up to 30 to 50% of cost of coverage
300
You can include the cost of these in medical expenses only if:
The food does not satisfy normal nutritional needs,
The food alleviates or treats an illness, and
The need for the food is substantiated by a physician (Letter of medical necessity)
What are Meal Replacements
300
Look for this when searching for Guidelines Specific to Your Services
What are Preventive Services
300
Face to Face Behavioral Counseling for Obesity including •One face-to-face visit every week for the first month;
•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 beneficiary meets the 3kg (6.6 lbs) weight loss requirement during the first 6 months
is considered this
What is Intensive Behavioral Therapy for Obesity
300
All providers and suppliers should carefully review these records in order to protect themselves and their practices from identity theft.
What are PECOS records
400
The USPSTF recommends intensive counseling, meaning more than 1 person-to-person (individual or group) session per month for at least the first 3 months, for
patients with this
What is 30% or more BMI
400
Wellness and health promotion services that are part of the basic benefits package of a managed health care plan.
What is Preventive Medicine
400
This coverage limits the number of covered Intensive Behavior Therapy sessions to 22 per year
What is Medicare
400
This modifier assists in the identification of preventive services in payer-processing-systems to indicate where it is appropriate to waive the deductible associated with co-pay or coinsurance and may be used when a service was initiated as a preventive service.
What is Modifier 33
400
The failure to submit claims for Medicare beneficiaries can be a penalty of up to $2,000 for each violation unless you have done this
What is Opted Out of Medicare
500
This year will be an important year for employers and employees. Insurance programs will provide benefit for preventive services which include counseling for obesity. Medicare will add the Annual Wellness Visit (AWV) and could be provided by your office.
What is 2014
500
Training available only to members diagnosed with the following conditions:
Coronary Artery Disease
Heart Failure
High Cholesterol
Hypertension
Obesity
Pre-Diabetes
Renal Failure/Renal Disease
What is Nutritional Counseling and Training
500
It was originally supposed to go into effect October 1, 2013 – the postponement will give until October 1, 2014 to come into compliance. It also contains over 76,000 codes, as opposed to the under-20,000 codes existing currently.