The Medicare annual wellness visit (AWV), sometimes referred to as a Medicare annual wellness exam, is an important part of keeping patients healthy. Unfortunately, the requirements concerning completing and documenting AWV appointments can be complex, so it is common for providers to inadvertently miss steps or fail to complete a requirement. In fact, as this Physicians Practice column by Prevounce CEO Daniel Tashnek, JD, notes, a survey from just a few years ago found that upwards of about 85% of Medicare AWVs may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS).
If you miss a requirement once, it may become the norm for you or your staff to skip that step in the Medicare AWV process. For instance, you may create a care plan for the patient, but not give it to them. Or you may create the service schedule, but neglect to personalize it to the patient. Any such oversight can diminish the value of the Medicare annual wellness visit and potentially lead to clawbacks and other penalties. Egregious and willful cases of noncompliance could lead to more serious ramifications.
Uncertainty concerning proper completion of the Medicare annual wellness visit can make it more difficult for providers and patients to get the most out of these wellness visits.
12 Items Needed for a Compliant Medicare Annual Wellness Visit
To help you better ensure every AWV is documented and completed properly, follow this Medicare annual wellness exam checklist.
1. Verify eligibility
Medicare, along with all types of insurance providers, has rules for the services a patient is eligible for and when. In the case of annual wellness visits, the timing of the appointment is particularly important. Medicare will only cover AWV appointments if a patient has been enrolled in Medicare for more than twelve months and has not had a wellness visit or "Welcome to Medicare" preventive visit in the preceding twelve months. Determining eligibility can be a
time-consuming process if not automated (such as through a AWV software platform like Prevounce) as it’s typically completed over the phone, through the MAC portal, or via clearinghouse. But verifying eligibility before any services take place helps protect both the provider organization and the patient from the financial burdens that can be caused by rejected claims. To help you better understand who is and is not eligible for the AWV, download this AWV eligibility quick guide.
2. Communicate requirements and expectations
Preventive health is a partnership between a provider and patient. For a patient to be fully prepared to participate in their annual wellness visit, it is important for organizations to proactively communicate so patients are aware of what they need to do to prepare, including the information they should bring to the AWV. It is also necessary to communicate what patients should expect from their visits.
Many people mistakenly believe a Medicare annual wellness visit will include a physical exam or other diagnostic procedures. Helping patients understand in advance what an AWV entails will help avoid both confusion and frustration. If you are wondering why Medicare does not cover annual physical exams, read this blog post.
If you are wondering why Medicare does not cover annual physical exams, read this blog post.
3. Complete a health risk assessment (patient responsibility)
Tasking patients with completing a health risk assessment (HRA) is a critical step in this Medicare annual wellness exam checklist because HRAs help providers identify factors that could negatively impact a patient’s health. They also provide clinicians with information needed to reconcile existing medication and health records with the patient’s responses, which is a required component of the Medicare AWV.
Ideally, assessments should be completed digitally before the patient comes to their appointment. Filling them out ahead of time allows the patient to allocate the necessary time to gather required information, such as family medical history or the names and dosages of their medications. However, if someone chooses to complete the health risk assessment in the office, technology like the Prevounce platform can still simplify the process for patients and providers.
4. Identify current medical providers
Many patients work with several providers to support their various healthcare needs. Creating a record of each of a patient’s providers, including pharmacies and medical equipment suppliers, is essential to understanding current and future medical needs.
5. Routine measurements
Another important part of the Medicare annual wellness visit is the practice of collecting vitals and other measurements. The simple practice of tracking information such as weight, blood pressure, and body mass index over time can help identify concerning trends in a patient’s health.
6. Cognitive assessment
Some Medicare patients may be at elevated risk for experiencing diminished cognitive abilities, which can negatively impact their quality of life and prevent them from caring for themselves. Assessing the cognitive awareness of patients is key to helping keep them healthy and safe by identifying cognitive decline earlier.
Cognitive assessments may be completed using formal tools, such as those provided by the National Institute of Aging, and/or they may be based on direct observation and input from family members, friends, and caregivers.
7. Mental Health Assessment
Mental health conditions, such as depression, negatively impact the lives of a growing number of patients. There are many screening tools, such as those provided by the American Mental Wellness Association, that can assist providers as they work to identify and then appropriately address these conditions.
8. Everyday living and safety assessment
As patients age, they may lose the ability to complete activities necessary for everyday living. As a result, it is crucial to screen for concerns such as a patient’s inability to fulfill their nutrition or hygiene needs. Assessing if a patient lives in an environment that does not put them at undue risk for falls or other accidents is also critical for helping keep them safe.
9. Document risk factors
Using the information gathered in all of the recommended assessments, it is important to compile and document a list of potential risks that may negatively impact a patient now or in the future. This list should include the risks themselves and advantages and disadvantages of any treatment options.
10. Provide a plan for the future
The final step* of the in-office portion of the Medicare annual wellness visit is to use the gathered information through the AWV process to provide a patient with guidance on how to maintain or improve their health. This process includes three important steps:
- Provide the patient with a personalized plan that includes specific medical advice and strategies for addressing identified risks.
- Work with the patient to create an actionable screening schedule that provides the patient with a checklist for all recommended preventive medicine screenings over a 5-10-year period.
- The third step, which is commonly missed, is to provide the patient with a physical copy of both the personalized patient plan and preventive screening schedule.
Since creating the screening schedule and personalized plan can be extremely time-consuming, automating these steps by using technology can reduce the time required for completing and significantly decrease the risk of errors.
This checklist should be based both on the results of assessments and on recommendations from the U.S. Preventive Services Task Force (USPSTF).
11. Coding and billing correctly
After a patient completes their appointment, the next item on the checklist is to correctly code and bill for the provided services. It is imperative that providers properly following the rules for Medicare annual wellness visit coding and billing as failing to complete the process correctly can result in either rejected claims or penalties incurred from being found non-compliant during audits. Either result translates to a loss of revenue for the provider. For assistance with following Medicare AWV coding and billing rules, read this post.
12. Optional: advanced care planning (ACP)*
We included an asterisk with item 10 of the checklist concerning providing a future plan for patients because there may be one additional step for the in-office portion of the Medicare annual wellness visit. Advanced care planning (ACP) is optional but covered under Medicare during AWVs. Issues such as who a patient trusts to make their medical decisions if they are unable to communicate or which medical interventions they are or are not comfortable with can be important issues to discuss and document. However, not all patients are comfortable talking about these topics, so advanced care planning should be done at the patient’s discretion.
Streamlining Completion of the Medicare Annual Wellness Visit With Prevounce
We designed the Prevounce platform to help make Medicare annual wellness visits more beneficial for patients and providers. Schedule a demo today to see how our platform provides the tools that make the AWV process simpler by automating pre-visit communication, verifying eligibility, supplying step-by-step walkthroughs, and providing coding and billing support so that annual wellness visits are completed, billed, and paid correctly every time.