An essential element of the Medicare annual wellness visit (AWV) is the personalized prevention plan, sometimes referred to as the personalized prevention plan of service or PPPS. During the annual wellness visit, you are expected to create or update the patient's Medicare personalized prevention plan. This requirement is clearly stated, both in the regulations and AWV HCPCS codes descriptors, and yet it is often neglected. When the PPPS is overlooked, the potential ramifications are significant. Providers run the risk of experiencing claims denials, needing to return payments if shortcomings are discovered during audits, and reducing the value of the AWV and PPPS to patients.
As Medicare.gov notes, the personalized prevention plan is designed to help prevent disease and disability based on a patient's current health and risk factors. Studies, such as one conducted by the Harvey L. Neiman Health Policy Institute that was published in Preventive Medicine, found that annual wellness visits, coupled with completion of the personalized prevention plan, increase the likelihood that patients will receive preventative health services. These include undergoing mammograms, prostate cancer screenings, colon cancer screenings, and receiving the influenza vaccine.
As Danny Hughes, one of the study's authors, states in a news release, "Promoting preventive care among the Medicare population is essential to enable the elderly to stay healthy, avoid or delay the onset of disease, and live productive lives."
Medicare Personalized Prevention Plan Tips
Follow these five recommendations to improve the development of a personalized prevention plan.
1. Understand the requirements.
If providers want to avoid the risks discussed above, they must ensure the PPPS is completed and done so properly during each AWV. Here is a summary of the core requirements:
- Produce a written preventive screening and services plan for the next 5-10 years, based on the following:
- recommendations of the United States Preventive Services Task Force;
- recommendations of the Advisory Committee on Immunization Practices (a committee within the U.S. Centers for Disease Control and Prevention);
- individual’s health risk assessment (HRA);
- individual’s health status;
- individual’s screening history; and
- appropriate, Medicare-covered preventive services.
- List patient-specific risk factors and conditions, including those identified during administration/update of the HRA, which would benefit from interventions or are already being addressed through interventions. Include mental health risks and conditions.
- Provide personalized health advice for these health concerns and risks.
- Identify any referrals to specialists, counseling services, and other programs
Within the regulations is the expectation that patients will be "furnished" with the personalized prevention plan and advice. While furnished is not specifically defined, it has been interpreted to mean either a physical copy of the PPPS handed to the patient upon completion of the AWV or a copy placed into a patient's active health portal account. A faxed copy is also considered acceptable if completed soon after the visit and only to address mistakes or exigencies but should never be considered part of standard workflow.
What is important to note that is that providing a copy of the HRA is not enough to qualify as a PPPS, nor is giving generic health advice that fails to speak to a patient's specific conditions. While you can provide a copy of the HRA and include generic health advice, they must be part of the more robust and patient-specific PPPS.
2. Help patients come to you prepared
Make sure patients know the information they should bring to the annual wellness exam that will help you assemble or update a complete Medicare personalized prevention plan. If patients come unprepared, you will likely need to spend more time discussing and documenting these details and may be faced with information gaps that hinder your ability to produce an effective plan.
Information patients should come prepared with includes:
- Names of all current physicians and their specialties
- List of all current self-management and community-based interventions, including those for mental health conditions
- Current medical records, including immunization and screening details
- Family health history
Also, ask patients to think in advance about any issues they want to discuss during their visit. This will help you better personalize the PPPS and advice you share.
3. Understand language needs
Another potential hindrance to completing the Medicare personalized prevention plan — and doing so in a timely fashion — is a language barrier. As a Centers for Medicare & Medicaid Services (CMS) report notes, an analysis of the 2014 American Community Survey (ACS), which is conducted by the U.S. Census Bureau, approximately 4 million or 8% of the 52 million beneficiaries are individuals with limited English proficiency. Spanish is overwhelmingly the most common language spoken by Medicare beneficiaries with limited English proficiency, with over half identifying Spanish as the language they speak at home.
When your staff schedule a patient's Medicare annual wellness visit, they should determine whether the patient is an individual with limited English proficiency. If so, they should work to identify the individual's preferred language and bring this to your attention. Knowing this information in advance will allow you to take the necessary steps to address such a barrier that can contribute to misunderstandings between you and the patient as well as extend the time spent on the visit. Such a step may include using language services.
4. Be prepared with a range of referral sources
As CMS notes, the personalized prevention plan should consist of referrals to educational and counseling services or programs aimed at community-based lifestyle interventions that can help reduce health risks and promote self-management and wellness. These include fall prevention, nutrition, physical activity, tobacco-use cessation, weight loss, and cognition.
To ensure the most personalized care possible, providers should have a list of options for referral sources for preventive and diagnostic services — internal and external to your organization — and work with patients to select the sources that make the most sense for their individual needs. Note: Providers are required by law to make all necessary referrals.
Issues to consider when making these choices are as follows:
- Accessibility. How easily can the patient get to the service or program? Factors to consider might include traveling distance, parking, and mass transit. Another consideration: hours for services of programs and whether they align with the patient's schedule. Any obstacles to accessibility will likely decrease the probability that the patient follows through on the referral.
- Language. As previously discussed, language can be a significant barrier to care. If a patient requires services in a language other than English, the referred service or program should be able to accommodate this need.
- Availability. Services and programs can come and go. Make sure you are working off as current of a list of referral options as possible. If a patient pursues a service or program only to find that it no longer exists or has moved to an inaccessible location, you may not know the patient failed to follow through on the referral until the next Medicare annual wellness visit.
- Cost. A patient's ability to cover the expenses of services or programs must be a careful consideration, especially considering reports highlighting the financial struggles of many Medicare patients. Costs that need to be considered are not just any fees associated with the services or programs themselves, but also those expenses associated with transportation (e.g., gas, tolls, parking fees, taxis), childcare, and pet care.
5. Invest in technology
There is a significant amount of information to cover and document in the development of a Medicare personalized prevention plan. The more time spent on personalized prevention plan creation, the higher the cost of each annual wellness visit. In addition, documentation shortcomings can lead to coding and billing errors as well as increase audit risks.
Fortunately, providers can invest in solutions that will help automate plan development, which can reduce time to complete annual wellness visits — potentially enough to fit more patients into your schedule — while also decreasing the chance of documentation mistakes.
One option we think you'll like is Prevounce. With the Prevounce platform, providers can streamline creation and completion of a compliant AWV with PPPS. Prevounce automates pre-visit outreach via text or email, helping patients come better prepared for their appointment and reducing the time spent by providers gathering background information. The platform simplifies the HRA, giving providers detailed information that allows them to ask more targeted questions that can help truly personalize the PPPS. Prevounce includes a personalized prevention plan creation feature that automates the plan and scheduling of preventive services. It even helps streamline billing and coding, so you receive fast, appropriate payments. Schedule a no-risk live demo now!