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June 2014
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  • Preventive or Diagnostic: A Critical Distinction under the ACA

    With implementation of the Affordable Care Act comes expanded coverage for preventative care and screening services - free of any co-pays, co-insurance and deductibles for patients' well care and annual exams.

    If a physician believes that ordering one or more of the recommended services is medically necessary under the United States Preventive Services TaskForce A and B Recommendations, then services may be free of the above-mentioned charges.

    However, if a patient has been previously treated for a disorder or has a known ailment, then some of the tests may be considered "diagnostic" instead of "preventative" and would then be subject to the deductible, co-payment and co-insurance.

    Learn more about how this works with ISMS' Issue Brief, Why am I Being Charged for Services That Were Part of My Annual Visit or Preventive Care?

    You can also download copies and hand out to patients.

    Questions? Please contact the ISMS Advocacy Team at 800-782-4767 ext. 1470 or by email.




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