13 May Are Medicare patients able to join?
Medicare patients are one group of patients that truly benefit from all of the features of a DPC practice.
Please note, however, that membership for a Medicare patient does require a separately signed mutual agreement that you, MyMD Direct, and Dr. Mabry will not file any claims to Medicare for services rendered by Dr. Mabry or MyMD Direct. By opting out of Medicare, Dr. Mabry can then perform a complete yearly physical exam instead of the Medicare Wellness Evaluation that is an approved benefit for Medicare beneficiaries.
If you have not already been seen for a Medicare Wellness Visit, this evaluation is directed by a questionnaire regarding the review of your past year of medical care including the names of your sub-specialty providers, dates of screenings and vaccinations, home safety evaluation, assessment of your memory, and screening questions for depression.
Based upon government regulations, physical contact with the patient is not allowed as part of your wellness visit. Ordering laboratory tests is allowed at the time of your wellness visit. However, any additional items including evaluating a patient’s concern, adjusting medications for a chronic condition, or even physically touching the patient to listen to their heart or lungs is considered a separate and mandatory billing in order to prevent a violation of Medicare rules.
Split billing or billing an office visit in addition to your wellness visit has become a prominent complaint of Medicare beneficiaries to healthcare providers. This procedure is truly not a decision that originates from your doctor. Hospitals and large clinics constantly monitor for any potential coding violations that may result in a Medicare investigation for fraud or enticement.
The US government has very strict enforced guidelines pertaining to what can be done during a Medicare Wellness Visit. A doctor that is intentionally giving “free” services is defined as “enticement” as it is felt the addition of non-covered services to the standard wellness visit provides a reason for more Medicare patients to seek care from this provider.
Medicare patients are entitled to all of the other benefits of MyMD Direct including real-time access to Dr. Mabry and relaxed/extended visits. This is particularly helpful when the Medicare patient has a complex medical history and treatment regimens that involve multiple sub-specialists prescribing medications.
The luxury of time gives Dr. Mabry and the patient the chance to coordinate their fragmented care, evaluate for the continued need for medications, and establish whether dosing adjustments are needed.
As part of the natural aging process, it is normal for a patient’s body chemistry to change, which results in the need for these dose adjustments (typically less medication) and gives consideration for the discontinuation of unnecessary or intolerable medications due to side effects.
Dr. Mabry feels strongly that hurried visits with a more complex patient can often lead to misunderstandings and/or misconceptions by the doctor and patient. Taking extra time with this particular patient population to thoroughly explain their medical conditions and involve them in their personal treatment decisions can improve their quality of life. In fact, stopping a medication that has become toxic to the patient can be a lifesaving intervention.