Managed Care Reimbursement

Medicare's Shift to Prevention's Means More Money for Screenings

Even as Medicare implements policies that favor preventive medicine and encourage more screening, many providers and patients remain unaware of these changes.  This may be an opportunity for laboratories to educate their referring physicians and patients about these new policies.

Medicare is increasingly willing to pay for screening tests and immunizations that previously were not covered.  However, the vast majority of Medicare recipients currently fail to take advantage of these benefits.  According to the Centers for Medicare & Medicaid Services  (CMS), fewer than one in 10 recipients gets all the screenings and immunizations recommended by public health groups and covered by Medicare.

Until now, only 5% of Medicare spending had been for preventative services.  In recent years, both Medicare and private insurers have responded to mounting evidence that preventing diseases such as flu, diabetes, and heart disease-instead of treating them-is the most cost-effective course of action for insurers.  "It is a fundamental change in the way Medicare thinks," says Herb Kuhn, acting deputy administrator at CMS. 

Medicare officials recognize that providers and patients are failing to take advantage of new policies for immunizations and screening tests. One way to get the word out has been the Medicare Prevention Bus Tour . The bus is visiting 130 cities in 48 states this summer.

Medicare Part B beneficiaries are eligible for many screenings and immunizations for free.  Others may require a 20% or 25% co-payment.  Part B beneficiaries do not have to meet an annual deductible, while Part A beneficiaries must meet a modest deductible of $131.  Dark Daily found a list of preventative services covered by Medicare in the MyMedicare.gov  FAQ.

Laboratories that want to take advantage of the wellness programs and free screenings offered by Medicare and private insurers should do their best to inform their patients that they are eligible for these benefits.  In blood draw centers, for instance, posters and educated phlebotomists can inform patients about the specific laboratory screening tests for which Medicare will pay and offer to collect samples for them while the patient is already present.  It seems to be one of those rare opportunities where changing Medicare policies on screening tests can benefit patients, as well as the laboratories that provide such tests.  Because of the clinical effectiveness of such wellness and preventive testing, it is good for patients, good for the Medicare program, and a positive outcome for the laboratory industry.

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