Right Wing Hysteria on Obamacare Preventative Exams

The right wing media and blogs have been posting hysterical. and factually incorrect, material on Obamacare since it was first proposed, including fictitious claims of Death Panels and false descriptions of the law as a government take over of health care. Now there is a new target of this misinformation campaign. The Affordable Care Act added preventative services to Medicare. Previously Medicare would only cover an office call for treatment of illnesses, but under Obamacare Medicare will also cover a preventative visit annually. As we all know, the right wing media frequently attacks laws by presenting misinformation to make them appear evil, or at least absurd. A post at Panama’s Media claims that if a patient is in the office for a preventative exam, a physician would be breaking the law for treating the patient for a medical problem.

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code — insurance will not cover any new ailment under that code.

If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.

You, the patient, will then have to make a decision.

Do you want your “free” yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my “free” exam if you only discuss what Obamacare wants me to discuss.

This happened to me personally, as a patient, when I went for my physical. It is the law. If you are complaining of a new problem, then you have to reschedule, since Obamacare is very clear as to what is covered and what is not. Obamacare — intentionally — makes it as difficult to be seen and taken care of as possible.

Patients can be very tricky. I have had patients make an “annual” exam, only to want to discuss and be treated for another ailment. I can’t do it.

The claims in the article are outright false. CMS has requirements for what must be included in a preventative exam if they are going to provide payment, but does not prevent a physician from going beyond this. Medicare does pay well for the preventative exams so if I spend an extra couple of  minutes discussing another problem it is no big deal. Medicare will pay if there is a significant medical problem which is addressed in addition to paying for the preventative exams. The instructions from CMS for billing of the new preventative services specifically state that an E&M (evaluation and management) code can be billed along with the code for the preventative services when there is evaluation of medical problems beyond the preventative services, as is stated in this pdf.

The addition of coverage for preventative services under the Affordable Care Act has provided additional benefits to patients, and in the long run should save money. There is no need to break the law as this post claims when combining a preventative exam with an examination for a medical problems. I have frequently billed for (and received payment for) claims containing billings for both preventative services and additional charges for evaluation of other problems the patient might be having.

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    John Sonntag says:

    RT @ronchusid: Right Wing Hysteria on Obamacare Preventative Exams #p2 #p21 #topprog http://t.co/8rJ2QcUv

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