Connection supplemental articles and policies – July 2015

Supplemental articles

Payment policies

These policies apply to Fallon Health and Fallon Total Care unless otherwise noted.
Revised policies – effective September 1, 2015:
The following policies have been updated; details about the changes are indicated on the policies.

  • Ambulance and Transportation Services Renamed to “Transportation Services,” moved to new plan template and updated language in reimbursement section.
  • Dermatology – Moved to new plan template and updated definitions section.
  • Durable Medical Equipment (DME) - Moved to new plan template and clarified capped language.
  • Home Health Care – Moved to new plan template and updated policy and reimbursement sections.
  • Hospice – Moved to new plan template and added code Q5010 to the billing/coding section.
  • Medical Supplies and Surgical Dressings – Moved to new plan template and updated lifetime supply limits in table at end of policy.
  • Nurse Practitioner – Moved to new plan template and updated to reflect addition of Advanced Practice Registered Nurse title.
  • Physician Assistant – Moved to new plan template and updated definition section.

Policies – annual review – effective September 1, 2015:
We have completed an annual review of the following policies and have reformatted them in our new plan template without any content changes.

  • Claims Auditing Software
  • Code Review
  • Coding Analysis
  • Counseling/Risk Factor Reduction Intervention Services
  • Emergency Department
  • Evaluation and Management
  • Global Surgical
  • Hospital Acquired Conditions
  • Infertility/Assisted Reproductive Technology (ART) Services  

Let’s connect

Fallon benefit supports older patients in managing weight

Between 2007 and 2010, more than one-third of U.S. adults over the age of 65 were considered obese.1 Overweight and obesity are growing concerns among the rapidly growing older adult population.

The primary drivers are poor diet and a sedentary lifestyle, and recent studies show that, over the last 10 years, sedentary behavior has emerged as a risk factor for health in older adults. The fact is, a high percentage of this population spends the majority of his/her time in sedentary activities.2

It is well-established that physical activity is a key factor in weight management, as well as in the prevention of many chronic diseases such as cancer, type 2 diabetes, cardiovascular disease and depression. Even armed with this information, however, convincing your patients to exercise and eat healthfully is easier said than done.

The Healthways SilverSneakers® Fitness program is designed to help you help them—and it works. In fact, 60% of SilverSneakers members (in comparison to 29%of older adults nationwide) reported their health as “excellent” or “very good.”3

That’s why Fallon offers its Fallon Senior Plan™ (FSP) Medicare Advantage, FSP Medicare Supplement and NaviCare® members access to the program, which provides a basic membership to select fitness facilities at no additional cost.

SilverSneakers is the nation’s leading physical activity program designed exclusively for older adults. The program makes it convenient, comfortable and fun for members to get active and make friends. Through fitness classes, social activities and a user-friendly website, Fallon’s senior plan and NaviCare members have a strong support system and the tools they need to eat healthfully and stay active. Encourage your patients to look into it.

For more information and a list of participating locations, visit or call SilverSneakers toll-free at 1-866-584-7389 (TRS 711), 8 a.m.–8 p.m., Monday–Friday.

3 2013 SilverSneakers Annual Member Survey

SilverSneakers® is a registered trademark of Healthways, Inc.
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