Your New Insurance Claims
Value-based physician payments appearing on insurance claims
Since 2014, the Patient Protection and Affordable Care Act ("Obamacare") requires insurance plans to cover many additional preventive & screening services, which may be reflected in your new Obamacare insurance claim/bills. To increase patient participation, Medicare and many commercial health insurers are changing the way they pay providers/physicians. Payments are now tied to meeting certain quality & value criteria. In order to receive payment, doctors are required to prove compliance with Obamacare's preventative & screening services by collecting and submitting information that fulfills these guidelines.
Most of this data is collected at the time of your annual comprehensive examination. This information is “de-identified” and sent anonymously – your personal answers and our findings are not linked to your insurance account.
New Criteria for Insurance Claims
You may have seen some of these new charges appearing on your “Explanation of Benefits.” These are simply the result of our office submitting proof that we met these quality and value criteria:
Alcohol Abuse Screening & Education
Patients with Medicare part B are screened for alcohol use. Our office includes this as a question on our history & review of systems annually. Patients are eligible for counseling if overusing alcohol. The patient pays no deductible.
Smoking & Tobacco Use Cessation
All Medicare Part B patients who use tobacco are provided screening & counseling. Our office includes tobacco use as a question on our history & review of systems annually. The patient pays no deductible.
Welcome to Medicare & Annual Wellness Visit
Patient’s lifestyle, vital signs, medications, labs, medical and family history are reviewed by our doctors to assess medical risks, and a list of recommendations for screening and prevention is given at the wellness visit. The patient pays no deductible.
We anticipate more of these charges to pop up in the next few years. As more of these criteria are introduced, our office will keep you informed.
