Definitions of Services Provided
- Annual Physical
An exam on a healthy person with no symptoms to look for hidden disease and give advice on healthy behavior. Getting the right preventive services at the right time can help you stay healthy by preventing disease or by detecting a health problem at an early stage when it may be easier to treat. - Does Not Include:
Medication refills, evaluation of new symptoms, or management of chronic problems. - Insurance Coverage:
Covered by most insurance. Not covered by Medicare, but may be covered by secondary insurance if Medicare patient has that.
- A visit to review chronic problems, adjust medications, check laboratory monitoring, or refill prescriptions. For some simple chronic problems (e.g., allergies), this may be once a year. For more significant problems, it may be at least twice a year.
- Does Not Include: Review of preventive services.
- Insurance Coverage: Covered by almost all insurance, including Medicare and Medicaid.
- Specialized planning visit to review which Medicare preventive services you need. Medicare requires that a standard set of questions be asked. They must include: review of functional status, depression screening, list of special medical equipment (if any), and list of other doctors. At the end of the visit, you receive a written summary of the services you require that are covered by Medicare. These might include cancer screening tests, EKG, blood tests, bone density tests, ultrasound, etc.
- Does Not Include: Medication refills or evaluation of new symptoms.
- Insurance Coverage: Medicare pays in full. There is no co-pay or deductible.
- An appointment to investigate a new symptom—such as chest pain, weight loss, or depression. Oftentimes, the problem may be quite complex, with multiple symptoms that require diagnostic tests and follow- up visits.
- Does Not Include: Medication refills for other problems or review of preventive services.
- Insurance Coverage: Covered by almost all insurance, including Medicare and Medicaid.
- Camp physicals, school physicals, work physicals, insurance physicals—this type of visit requires the doctor to fill out a form. Services include whatever is necessary to fill out the form.
- Does Not Include: Medication refills or evaluation of new problems.
- Insurance Coverage: Sometimes covered by insurance, but often not. In cases where a form is needed a short time after an appointment (i.e., child had an annual Well Child Exam to update immunizations and three months later needs a form filled out for camp), the doctor may be able to complete the form without another visit. However, there is a fee to fill out the form and that fee is usually not covered by insurance.
Well-woman exams may include a pap smear, a pelvic exam, and a breast exam if you are due for all three services. These exams are important to your health since they can catch early signs of cancer or other health problems before they progress.
- Does Not Include: Medication refills, evaluation of new symptoms, or management of chronic problems.
- Insurance Coverage: Covered by almost all insurance, including Medicare and Medicaid.
Coding for Your Insurance
The difference between medical services is sometimes hard to understand. As a physician practice, FPCA does not control these differences. Our reimbursement is based on the coding system that insurance companies use to describe medical work. For example the coding system classifies a physical exam and medication refill as two separate services. Think of it this way: you wouldn’t expect to make a restaurant reservation for three people, and then bring a fourth person for free. We have to follow what the insurance companies dictate according to the rules of our contract. This is true for all medical providers.