medicare annual wellness visit (awv)

Copyright 2015. All Rights Reserved. www.medicareawv.info

What is it and why does it matter to my practice?

MEDICAREANNUAL WELLNESS VISIT

Charles P. Smith, RN BSNCEO, Innovative Health Media


History of the Annual Wellness Visit (AWV)

Funded by the 2010 Affordable Care Act

Started shift to preventive care

Increased reimbursement potential for primary care providers (PCP)

Medicare began reimbursing in 2011, and patient has NO COPAY


Who is eligible for an AWV?

Within first 12 months of Medicare coverage

Months 12-24 of Medicare coverage

Months 24+ of Medicare coverage

HCPCS Code

IPPE (Welcome to Medicare Exam) X G0402

Initial AWV X (must be at least 12

mo after IPPE)

X(if no previous AWV

performed)G0438

Subsequent AWV X (must be at least 11 months, 1 day after

Initial AWV)

X (must be at least 11 months, 1 day after

previous AWV)

G0439

Any patient with Medicare Part B or Medicare Advantage (Part C) is eligible as shown in the table below:


The reimbursement rate is dependent on your geographic area, but in 2015 the National Payment Amount for the IPPE and AWV were:

IPPE (G0402) : $168.89 Initial AWV (G0438) : $174.28 Subsequent AWV (G0439) : $117.86

What is the reimbursement rate?


Can perform and bill under physician NPIAny place, anywhere

Can perform and bill under own NPI Any place, anywhere

Can perform entire AWV under “direct supervision” of the billing physician

Can collect data but a provider must complete visit and bill under provider’s NPI

Physician XNurse Practitioner X (85% reimb rate)Physician Assistant X (85% reimb rate)RN/LPN XMedical Assistant X

Who can perform the AWV in my practice?


Annual Physical Exam “Sick visit”

WHAT IT IS NOT

“Well Visit”, designed for a discussion with your patient

Review of your patients history, meds, immunizations, providers

Health Risk Assessment Detection of potential issues not

found in normal physical exam Creation of a preventive care plan

WHAT IT IS

What is the Annual Wellness Visit?


Patient will: Learn about their own health Receive a written preventive plan Receive a written eligibility

schedule of free screenings for next 5-10 years

Obtain additional services if needed

Practice will: Obtain a more thorough history

on your patients Increase your reimbursement

from Medicare Discover needs for additional

services Improve quality measures for

MIPS and PQRS

Benefits to your practice and patients


Medicare has laid out very specific requirements that must be met in order to be reimbursed for the AWV.

General Medicare requirements can be found at: www.cms.gov

For more details, visit our website at: www.medicareawv.info

What are the specific requirements of the AWV?

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf

http://www.medicareannualwellnessvisit.info/


Failure to meet the Medicare requirements will put you at risk in an audit or if a patient complains.

Medicare audits are performed by contractors that are paid based on how much they recover, so they will be looking at details.

You must maintain an adequate audit trail to show you are meeting the requirements.

The templates in most EHRs do not meet all the requirements.

What are my audit risks?


Evidence that you reviewed the patients history (beyond what was already in your EHR)

Review and document ALL of the

patients medications including OTC, herbal supplements, vitamins and prescribed by other providers

Common audit issues to be aware of:


Develop a list with contact information for all of the patients providers including pharmacies, dentists, home health agencies, durable equipment providers, chiropractors, and other specialists



Provide a written Personal Preventive Plan to the patient which must include eligibility dates for the Medicare free preventive screenings for the next 5-10 years.



Utilize a consistent, reliable system that meets the requirements for every person receiving an AWV

Keep a copy of the Health Risk Assessment in your records

How to minimize your risk


Make sure the patient gets a printed PPPS and keep a copy in your records

If you haven’t been meeting the requirements, notify Medicare and fix it immediately or risk the consequences.

How to minimize your risk


There are many electronic AWV systems available, here are a few things to look for: Systems vary from easy to complex Some may try to upsell you additional services. Decide what you need, and don’t pay for extras that will just confuse your staff

and patients. Very few EHRs allow interactivity between other vendors and their EHR without a

hefty fee structure. Look for systems that include full training and support in the initial price.

Just search for: electronic AWV, AWV templates, or e-AWV

Electronic AWV Systems


If you have any questions I have not addressed, please check our website at www.medicareawv.info , or contact

me directly at [email protected]

THANK YOU FOR YOUR INTEREST

http://www.medicareawv.info/

mailto:[email protected]

medicare annual wellness visit (awv)

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