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How Can Physicians Manage Patients’ Annual Wellness Visit better?

What is AWV?

In the year 2011, the Center for Medicare and Medicaid Services (CMS) introduced the Annual Wellness Visit (AWV). An AWV is a yearly appointment of the patient with the physician funded by the American Affordable Care Act.  It is very different from an Annual Physical Exam and is more of an educational visit than a diagnostic one. During this visit, the physician formulates a preventive plan for the patient for the coming year. This plan can help in preventing illness based on current health and risk factors.

Eligibility Criteria

Medicare provides Personalized Prevention Plan Services (PPPS) under the wellness plan for beneficiaries who:

  • Are no longer within 12 months after the effective date of their first Medicare Part B coverage period
  • Have not received an Initial Preventive Physical Examination (IPPE) or Medicare yearly wellness visit within the past 12 months

The following medical practitioners are eligible for providing Medicare yearly wellness visit services to patients:

  • Physician (a doctor of medicine or osteopathy)
  • Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
  • Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioners), or a team of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)

Medicare Wellness checklist

  1. Initial Annual Wellness Visit – This is applicable the first time a beneficiary receives an Annual Wellness Visit. It includes the following components:
  • Acquire Beneficiary Information: The physician assesses the health risk factors of the patient. It includes analyzing patient self-reported information, demographic data, daily activities, etc. He/She collects data from the list of physicians who regularly treat the patient. The physician reviews the beneficiary’s medical and social history,  completely studies the patient’s potential risk factors, mood disorders, functional ability and level of safety.
  • Begin Assessment: The physician begins the assessment by measuring the patient’s vitals. He/She identifies the patient’s illness through direct observation, medical history, concerns raised by family members, friends, caretakers, etc.
  • Counsel Beneficiary Action: The physician establishes a written screening schedule for the beneficiary, such as an appropriate checklist for the next 5 to 10 years, etc. He/She furnishes personalized health advice to the beneficiary and generates appropriate referrals to specialist clinics or imaging centers. The physician gives advance care planning at the discretion of the beneficiary.

The subsequent Medicare yearly wellness visits include the above components and will be updated on the later patient visits.

Billing Codes for Medicare Yearly Wellness Visit

G0438 $117 Annual wellness visit which includes a personalized prevention plan of service (PPS) and the first visit
G0439 $173 Annual wellness visit which includes a personalized prevention plan of service (PPS) and the subsequent visits

Tips for physicians to benefit from Annual Wellness Visit

  • Managing patients – All Medicare Part B patients are eligible for Wellness Plan services. It is necessary for the practice to find the right patients who would benefit from this service. The physicians must give the patients a clear idea of how Medicare Wellness Program process works, what they can expect from the service, etc. The practice must make the patients aware of the reimbursements and the additional charges they may incur depending on their insurance coverage.
  • Developing protocols for schedulesA Medicare Wellness Program takes a great deal of both staff and physician resources to give the service. It is better for a practice to take some time to decide how these appointments best fit into their existing schedule. Creating a scheduling protocol will save more time and frustration. For example, how many days in a week, the practice can schedule these appointments, what tool for tracking the Medicare Wellness Program services, patient records, reimbursement rates, etc.
  • Pre-visit planning – The practice must verify not only the patient’s Medicare Part B effective date but also whether the patient has received a Wellness Plan from any physician in the last 11 months. Otherwise, Medicare may deny the service, leaving the patient with an unexpected bill. The practice must do the same verification for other preventive services that patients receive along with the Medicare Yearly Wellness Visit. It is ideal to have the staff note the last date of these preventive services on a Medicare Yearly Wellness Visit documentation form in advance of the visit. This will help in determining which preventive services are needed and whether the patient is eligible to have these paid for by Medicare. A pre-visit history can also find whether the patient needs any laboratory tests such as the cardiovascular scans, diabetes screening blood tests, etc. These should be completed prior to the Medicare Yearly Wellness Visit to allow discussion of its results at the visit.
  • Planning for effective follow-up care – The physician should analyze the patient’s risk factors and problems accurately during the Medicare Wellness Program. The physician must generate a care plan for the patient considering these factors. It is necessary to develop a preventive service plan and a general checklist for the next ten years. The physicians should follow-up the same on the patient’s subsequent Medicare Yearly Wellness Visits.
  • Getting complete reimbursementsThe last step in providing the Medicare Yearly  Wellness Program is to get paid the service rendered. AWV attracts the physicians’ attention because of the reimbursements offered by Medicare. The practice must keep up a clear documentation to make the process hassle-free.

These practices simplify the Medicare Wellness Program process thereby improving the efficiency of the practice. The HealthViewX solution eases the AWV workflow for the practice. With HealthViewX solution, there is no chance of losing the reimbursements. To know more about HealthViewX solution, schedule a demo with us.

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit (AWV) is becoming increasingly significant in preventive healthcare services and there are many questions surrounding AWV and its actual benefits. Here is our answer to some of the trending questions:

Is Annual Wellness Visit the same as an Annual Physical Exam?

The immediate answer is a No, AWV is not the same as an annual physical exam. Medicare will cover an Annual Wellness visit but not an annual physical exam.  Under the Affordable Care Act (ACA), Medicare covers AWV completely, with no co-payment and no patient deductible. This is only valid  if the services provided during the visit meet specific criteria for information-gathering, assessment, and counseling.

What’s the difference between AWV and Annual Physical Exam in terms of patient assessment?

The premise of an Annual Physical Exam is to study the body and determine if there is any physical problem with the patient. On the other hand, the Annual Wellness Visit is to identify risks and then mitigate those risks by referring the patient to an appropriate resource.

Medicare Wellness is a holistic assessment routine

Annual Physical Exam is a measurement routine

  • The Doctor will measure height, weight, blood pressure and other routine measurements
  • The Doctor will assess your risk factors and treatment options
  • Review Health Risk Assessment questionnaire
  • Updating list of providers and prescriptions
  • Looking for signs of cognitive impairment
  • The Doctor will set up a screening schedule for appropriate preventive services
  • The Doctor will review your medical and family history
  • The Doctor will measure height and weight; blood pressure; BMI
  • The Doctor will assess your risk factors for preventable diseases
  • The Doctor will perform head and neck; lung; abdominal and neurological exams
  • The Doctor will check vital signs and test your reflexes
  • The Doctor may conduct any blood work or lab tests
  • The Doctor will review your medical and family history

The purpose of Annual Wellness Visit under Medicare is to record the current state of health and to create a starting point for the future. Medicare also covers a number of other preventive services such as preventive cancer screenings, bone density measurement, and flu shots free of cost.

The most important question would be – How is the delivery of an AWV— a preventive care service related to HealthCare Technology?

As a service, AWV is good for both patients and for HealthCare System’s Strategic Objectives. The manual processes involved in delivering AWV can be guided by an automated workflow tool. This tool can enable providers to create an assessment, create personalized care plans, set automated reminders, streamline documentation and educate the eligible population.

AWV intervention points for a tool/software platform like HealthViewX –

Patient eligibility verification Assessment/Scheduling of patient visit Patient visit/ Conducting the routine AWV reports Billing of Medicare CCM Suggestion
Done by HealthViewX Done by HealthViewX Done by Provider Done by HealthViewX, reviewed by Provider, shared with patients Done by Provider Suggest providers to enroll eligible patients for CCM

Empower your practice with HealthViewX’s smart and streamlined AWV and make the most out of Medicare’s profitable wellness program both for your practice and your patients.