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Primary-care docs to get 10 percent Medicare bump next year. New wellness exam covered, too.

Primary-care docs to get 10 percent Medicare bump next year. New wellness exam covered, too.

As part of an effort to boost America’s flagging primary care industry, Medicare says it will offer a 10 percent bonus to doctors who perform mostly primary care services in 2011, and will begin paying for an annual “wellness exam” to supplement its one-time-one “Welcome to Medicare” physical.

For struggling primary care physicians, these changes should be warmly received. Yet they are still not well known, even though they begin next month, in part because the details them have just recently been finalized through the regulatory process—but also because Medicare has done its usual sub-par job of communicating changes to providers.

Medicare patients will love the annual wellness exam, during which physicians (nonphysician providers such as NPs and PAs are also eligible) are to draw up an individualized prevention plan for patients to include “a written screening schedule for the next [five] to 10 years, based on recommendations of the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices,” according to the American College of Physicians. Find out more about what’s to be covered here. The exams figure to be lengthy, but the Centers for Medicare and Medicaid Services (CMS) said it will pay for them as level-4 visits. In 2010, Medicare paid $131.37 for a 99204 (new patient) and $92.37 for a 99214 (established patient).

Patients who’ve already had the Welcome to Medicare exam can get the new wellness exams starting Jan. 1. Others must first get the Welcome to Medicare physical; they would then be eligible for the annual wellness exam the following year, and each year thereafter.

CMS also said that in 20011, it will begin paying a 10 percent bonus to family physicians, internists, geriatricians, pediatricians, NPs, PAs, and certain clinical nurse-specialists “for whom primary care services represent 60 percent or more of their [Medicare physician fee schedule] allowed charges in a prior period.”


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