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Vital Brain Aging Clinical Path Overview

  • Educate

  •  

    Assess

  • The Methods

  • Diagnosis

  • Treatment













Select Patients for Assessment

As described in more detail below, many patients should have their cognition assessed while many others need not. Following these basic guidelines will ensure that you offer your patient population the highest justifiable standards of care in an economically prudent manner.

Establishing Medical Necessity

Insurance companies including Medicare do not reimburse routine memory assessment without medical necessity. Any one or more of the following establishes medical necessity:

  • A concern expressed by the patient
  • A concern expressed by the patient's family member or caregiver
  • A concern or observation by the physician or medical staff

Office Visits for General (non-cognitive) Care

Regardless of the purpose of the patient's visit, it makes good sense to be vigilant about signs of memory loss in your "at-risk" or Medicare population, and to assess memory when medical necessity is met. The Healthy Brain Checklist is a short, check-box form that should be provided to patients at registration for each visit to your office. This is an excellent mechanism for proactively identifying early problems and for enabling patients to document medical necessity for further assessment. Patients should have their memory assessed only if they meet medical necessity.

Be Aware of the "High Risk" Group

Those patients aged 50 and older with any one or more of the following risk profiles, warrant attention and should certainly have the opportunity to either complete the Healthy Brain Checklist or be engaged in a direct discussion about their cognitive health.

  • Personal history of stroke or head injuries
  • Family history of AD or related disorders
  • Cardio-vascular risks including high cholesterol, hypertension, obesity, smoking
  • Diabetes

All of these patients are at higher risk for cognitive problems, but do not meet medical necessity for further cognitive assessment based solely on their risk profile. These patients should be made aware of their increased risk and have their memory assessed only if they meet medical necessity (as outlined above).

Medicare Routine Physical Exams

Beginning in January 2011, CMS will honor two new reimbursement codes*, one for a "Welcome to Medicare Visit" that can be used within the first year of Medicare eligibility, and one for an annual "Medicare Wellness Visit." The guidelines for each of these visits stipulate that the physician assesses the patient for cognitive impairment. All of these patients should complete the Healthy Brain Checklist.

* Centers for Medicare Services established the two following codes taking effect on January 1, 2011:

  • G0438 - Annual Wellness Visit; includes a personalized prevention plan of service (PPPS), first visit
  • G0439 - Annual Wellness Visit; includes a personalized prevetion plan of service (PPPS), subsequent visit

Any patient you see for an Annual Wellness Visit, who indicates a concern on the Healthy Brain Checklist, should be further evaluated. Guidelines for such further evaluation are summarized under "Select Appropriate Cognitive Assessment Method."

The Healthy Brain Checklist

Insurance companies including Medicare do not reimburse routine memory assessment without medical necessity. Any one or more of the following establishes medical necessity:

This short, check-box form can be completed by patients at registration in less than two minutes. Use it to identify early stage problems and to document medical necessity for an assessment.

Download here
Email: physician@ocvitalaging.org
Phone: (949) 764-6288