The results of a survey suggest that upwards of about 85% of Medicare annual wellness visits (AWV) may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS). The results should motivate providers to verify that the tools they are using during AWVs for Medicare patients effectively prompts them to ensure no required components are missed. If a required element is missed, the AWV can be considered non-compliant by an auditor, potentially leading to clawbacks and other penalties. In egregious and willful cases, a non-compliant practice could even face exclusion from Medicare or criminal liability.
Background on the Medicare Annual Wellness Visit Survey
The web-based survey was conducted by the American Academy of Family Physicians (AAFP) National Research Network, the practice-based research network of the AAFP. It was completed by 159 primary care providers from 145 practices in 36 states. The intent of the survey was to explore the variability in the assessments and tools used by physicians during the Medicare annual wellness visit. One of the central questions asked of providers taking the survey was whether they were using an assessment tool within each of the AWV required elements. CMS does not specify how providers should conduct the AWV assessment.
The results of the survey, which was conducted in March 2019, were published in the May 2022 issue of the Journal of the American Board of Family Medicine.
AWV Survey Results: Key Compliance Takeaways
The annual wellness survey results raise many red flags. Among them:
- About 1 in 5 respondents are not using a health risk assessment (HRA). The HRA is a fundamental component and requirement of the AWV.
- About 16% are performing a driving safety assessment. In the annual wellness visit conditions for coverage, "motor vehicle safety (seat belt use)" is identified as a behavioral risk topic that must be evaluated as part of the HRA. This survey result suggests that more than 80% of all AWVs may risk non-compliance in this small area alone.
- A home safety assessment — another such behavioral risk topic required as part of the health risk assessment — is only addressed in about half of AWVs.
- More than 40% of respondents are not performing the required nutritional/diet assessment.
- Providers did not establish a list of current physicians and providers regularly involved in the patient's medical care for about one-third of all AWVs.
- Cognitive function is often not addressed. A validated memory screening tool is used under 70% of the time and cognitive measures assessed via direct observations or family concerns are completed for 66% of AWVs.
The researchers call for greater standardization concerning how providers should be conducting the annual wellness visit and meeting its evaluation criteria. They hope that doing so "may improve uptake, quality and efficiency of the AWV."
How Prevounce Approaches the Medicare Annual Wellness Visit
At Prevounce, we take annual wellness visit compliance seriously because we know Medicare and auditors take it seriously. That's why our platform is kept current with requirements and prompts providers and their clinical staff to complete every required step of the AWV. The platform then generates comprehensive documentation that can be used in the case of a chart check or audit.
Furthermore, we help providers navigate the health risk assessment and supply all the tools that can be used for compliance, including eligibility checks, automated preventive care schedule creation, and automatic report generation. The results: consistent quality of care; documentation achieved in a streamlined, cost-effective manner; and claims and payments that will withstand the scrutiny of auditors. Learn how Prevounce has developed Medicare annual wellness visit software that works for everyone.