Medicare's Evidence of Coverage Requires Fall Risk Assessment
Medicare is the payor whose evidence of coverage calls for fall risk assessment in community-dwelling older adults. 1
Evidence for Medicare's Fall Risk Assessment Requirements
- Medicare coverage policies include fall risk assessment as part of preventive care for older adults, based on the U.S. Preventive Services Task Force (USPSTF) recommendations 1
- For multifactorial risk assessment with comprehensive management, Medicare coverage is specifically mentioned as a current consideration in implementation of fall prevention services 1
- Medicare reimbursement policies support case management and coordination of services related to fall risk assessment and prevention 1
Components of Fall Risk Assessment Covered by Medicare
- Brief fall risk assessment using history of falls, mobility problems, and timed Get-Up-and-Go test performance 1, 2
- Annual screening is recommended for all adults aged 65 and older, as 30-40% of community-dwelling adults in this age group fall at least once per year 2
- The timed Get-Up-and-Go test is a primary care screening tool where healthy adults over 60 should complete the task in less than 10 seconds 1, 2
Medicare-Covered Interventions Following Risk Assessment
- Exercise or physical therapy interventions, which have demonstrated moderate benefit in preventing falls with high certainty of evidence 1, 2
- Vitamin D supplementation, which has shown moderate benefit in preventing falls with moderate certainty of evidence 1, 2
- Multifactorial risk assessment with comprehensive management of identified risks, which has at least a small benefit in preventing falls 1, 2
Implementation in Clinical Practice
- Medicare's coverage policies align with the American Geriatrics Society (AGS) recommendations for fall risk assessment 1
- Primary care providers play a key role in implementing Medicare-covered fall risk assessments 3
- Medicare-certified home health agencies have implemented evidence-based fall prevention practices following standardized training 4
Practical Considerations for Medicare Coverage
- Insurance coverage and cost of services are specifically mentioned as barriers to widespread adoption of multifactorial risk assessment and physical therapy interventions 1
- The multifactorial nature of fall risk requires close case management and coordination of services, which Medicare has provisions to reimburse 1
- Medicare coverage policies prioritize evidence-based interventions that demonstrate reduction in morbidity and mortality related to falls 2