MEDICARE COVERAGES Flashcards
(41 cards)
How often can a qualified Medicare Beneficiary receive each of the following services:
PSA Screening & DIGITAL RECTAL EXAM
1/YR; PROSTATE-SPECIFIC ANTIGEN PSA TEST
1 YR Digital Rectal Exam
50 yrs or older (Starting the day after 50 birthday)
Beneficiary Obligation in orig. Medicare Plan
DIGITAL RECTAL EXAM - COPAY, COINSURANCE, DEDUCTIBLE APPLY
PSA TEST - ALL WAIVED
A screening test for diabetes, if diagnosed with pre-diabetes
2 SCREENINGS / YR Beneficiaries who have certain risk factors for diabetes OR have been diagnosed with pre-diabetes
1 SCREENING / YR if previously tested but not diagnosed with pre-diabetes, or if never tested.
ALL WAVED
How often can a qualified Medicare Beneficiary receive each of the following services:
DIABETES SELF-MANAGEMENT TRAINING ( DSMT)
Flup subsequent years
10 hours of initial training / 12 mth period.
In subsequent years,
2 hours follow-up training are allowed / each yr
COPAY, COINSURANCE, AND DEDUCTIBLE** APPLY**
How often can a qualified Medicare Beneficiary receive each of the following services:
Annual Wellness Visit
Beneficiaries who
are > 12 months after effective date of MEDICARE B
WHO HAVE NOT RECEIVED AN INITIAL EXAM IPPE OR AWV IN LAST 12 MONTHS
ALL WAVED
How often can a qualified Medicare Beneficiary receive each of the following services:
BONE MASS MEASUREMENTS
2 yrs or more often if medically necessary
Covers Those AT RISK FOR LOSING BONE MASS OR developing OSTEOPOROSIS
ALL WAVED
How often can a qualified Medicare Beneficiary receive each of the following services:
CARDIOVASCULAR DISEASE SCREENING
5YR
ALL ASYMPTOMATIC BENEFICIARIES
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
COLORECTAL CANCER SCREENING
AGE 50 AND OLDER -
FLEXIBLE SIGMOIDOSCOPY WAVED
BARIUM ENEMA – COINSURANCE APPLIES, DEDUCT WAVED
MULTITARGE STOOL DNA TEST - IF POLYP FOUND AND REMOVED,
20% COPAYMENT APPLIES
How often can a qualified Medicare Beneficiary receive each of the following services:
COLONOSCOPY
Fecal occult blood test - 1 yr
Flexible sigmoidoscopy yrs, or 10yrs after having a screening colonoscopy
Colonoscopy 2yrs if hi risk or 10 yrs if not
Barium enema 2 yrs if hi risk or 4yr if not
NO AGE LIMIT
MULTITARGE STOOL DNA TEST All WAVED
Barium enema - deduct applies
Multitarget stool DNA test - IF POLYP FOUND AND REMOVED,
20% COPAYMENT APPLIES
How often can a qualified Medicare Beneficiary receive each of the following services:
GLAUCOMA SCREENING
Those at risk of glaucoma-with diabetes, family history, african-american 50 +, hispanic > = 65
COPAY, COINSURANCE, AND DEDUCTIBLE APPLY
How often can a qualified Medicare Beneficiary receive each of the following services:
HEPATITIS B (HBV) VACCINE AND ADMINISTRATION -
SCHEDULED DOSAGES, AS REQUIRED
THOSE AT INTERMEDIATE OR HIGH RISK FOR GETTING HEP B
Those currently positive are NOT ELIGIBLE FOR THIS BENEFIT
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
HEP C VIRUS (HCV) SCREENING
1/yr for high-risk beneficiaries with injections or had a blood transfusion before 1992
1 / lifetime if born between 1945 - 1965 and not at high risk
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
HIV HUMAN IMMUNODEFICIENCY VIRUS SCREENING
Those with increased risk, or between 15-65 and ask for test
ALL WAVED
How often can a qualified Medicare Beneficiary receive each of the following services:
initial preventive physical exam IPPE - WELCOME TO MEDICARE
ONCE IN LIFETIME
ALL WHO ARE WITHIN FIRST 12 MONTHS OF THEIR FIRST PART B COVERAGE PERIOD
COPAYMENT AND COINSURANCE APPLY – DEDUCTIBLE WAIVED
IPPE WITH EKG – ALL COPAY, COINSURANCE, DEDUCTIBLE APPLY
How often can a qualified Medicare Beneficiary receive each of the following services:
INTENSIVE BEHAVIORAL THERAPY (IBT) FOR CARDIOVASCULAR (CVD)
1 CVD RISK REDUCTION VISIT ANNUALLY
THOSE COMPETENT AND ALERT AT TIME OF COUNSELING IS PROVIDED
THOSE WHOSE COUNSELING IS FURNISHED BY QUALIFIED PRIMARY CARE OR OTHER PRIMARY CARE PRACTITONER IN PRIMARY CARE SETTING
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
INTENSIVE BEHAVIORAL THERAPY FOR OBESITY
ANNUALLY FOR ALL: FREQUENCY OF COVERAGE INCLUDES:
1 VISIT / EVERY WEEK FOR MONTH 1
1 VISIT/ EVERY OTHER WEEK FOR MONTH 2-6,
1 / MONTHLY FOR MONTHS 7-12
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
LUNG CANCER SCREENING
ASYMPTOMATIC AND SMOKET 30 PACKS - YEARS
(1 PK-YEAR IS = TO SMOKING 1 PK/DAY FOR 1 YEAR)
1 PK = 20 CIGARETTES
WHO ARE CURRETLY SMOKERS OR HAVE QUIT SMOKING WITHIN 15 YEARS.
THERE MUST BE A WRITTEN ORDER THAT MEETS SPECIFIC CRITERIA SET BY CMS
COINSURANCE AND DEDUCTIBLE WAIVED IF CRITERIA MET, HAS WRITTEN ORDER, AND PHYSICIAN ACCEPTS ASSIGNMENT
How often can a qualified Medicare Beneficiary receive each of the following services:
MAMMOGRAM SCREENING
1 Baseline screening between 35 and 39
1/yr every 12 months for > 40
if screening and DIAGNOSTIC billed on same day - a modifier GG should be used to show screening was turned into diagnostic mammo at TOS
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
MAMMOGRAM DIAGNOSTIC
US GG MODIFIER IF SCREENING IS TURNED TO DIAGNOSTIC AT TOS
FEMALES WHEN SERVICE IS MEDICALLY NECESSARY
COINSURANCE, DEDUCTIBLE MAY APPLY
How often can a qualified Medicare Beneficiary receive each of the following services:
MEDICAL NUTRITION THERAPY MNT
3 hours of 1 on 1 counseling - year 1
2 hours of 1 on 1 counseling - each year 2 +
those diagnose with diabetes or renal disease or received a kidney transplant within last 3 years
ALL WAIVED
NOTE: IF RECEIVING DIALYSIS IN A DIALYSIS FACILITY, MEDICARE WILL COVER MNT(medical nutrition therapy) AS PART OF THE OVERALL DIALYSIS CARE.
How often can a qualified Medicare Beneficiary receive each of the following services:
PAP SMEAR & PELVIC EXAM (incds breast exam)
1 / 24 mths or 1/12 mths if at risk for cervical or vaginal cancer
or of childbearing age with an abnormal pap in the preceding 36 mths (3yrs)
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
Screening and behavioral counseling to reduce alcohol misuse
1/YR 1 on 1 face to face for all
up to 4 times / year who screen positive
those positive eligible for counseling if they are competent and alert at the time the counseling is provided & COUNSELING IS FURNISHED BY QUALIFIED PHYSICIANS IN PRIMARY CARE SETTING
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
Screening for cervical cancer with human papillomavirus (HPV) tests
1/5 YRS
ALL ASYMPTOMATIC FEMALES AGES 30 - 65
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
Screening for depression -
1/YEAR ANNUALLY FOR ALL
ALL WAIVED
How often can a qualified Medicare Beneficiary receive each of the following services:
Sexually transmitted infection (STI) screenings and high intensity behavioral counseling to prevent STIs -
1/YR for all
frequency of coverage depends on the type of STIs being treated.
Adolescent and adult beneficiaries who are sexually active and are at an increased risk for STIs
ALL WAIVED
Behavioral counseling sessions conducted in an inpatient setting will not be covered as preventive services.
