Annual Wellness Exam Medicare Checklist: 12 Items for Providers

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by Lucy Lamboley

Medicare Annual Wellness Visits (AWV) are an important part of the process of keeping patients healthy. However, the required procedures surrounding AWV appointments can be complex, so it is common for providers to inadvertently miss steps or leave requirements incomplete. If you miss a requirement once, it may become the norm for your staff to skip that step in the AWV process. For instance, you may create a care plan for the patient, but not give it to them. Or create the service schedule, but neglect to personalize it to the patient.

This uncertainty can make it difficult for medical providers to get the most out of these wellness visits, for both their patients and their practices. To help you overcome this obstacle, we put together this Medicare Annual Wellness exam checklist for providers to use as they navigate Medicare requirements.

1. Verify Eligibility

Medicare, along with all types of insurance providers, has particular 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. This can be a time-consuming process if not automated 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 medical practice and the patient from the financial burdens that can be caused by rejected claims.

2. Communicate Requirements and Expectations

Preventive health is a partnership between the provider and the patient. For a patient to be fully prepared to participate in their wellness visit, it is important for medical practices to proactively communicate so that patients are aware of what they need to do to prepare, including the information they should bring. It is also necessary to communicate what patients should expect from their visits.

Many people mistakenly believe that an AWV will include a physical exam or other diagnostic procedures. Helping patients understand in advance what an Annual Wellness Visit entails will help avoid both confusion and frustration.

3. Have Patient Complete an HRA

Health risk assessments are a critical step in any annual wellness exam Medicare checklist because they help providers identify factors that could negatively impact a patient’s health. They also provide doctors the information needed to reconcile existing medication and health records with the patient’s responses, which is a required piece of an AWV. Ideally, these assessments should be completed digitally before the patient comes to their appointment. Filling them out ahead of time allows the patient 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 can still simplify the process for both the patient and the provider.

4. Identify Current Medical Providers

Many patients work with several providers to address all of their healthcare needs. As a result, creating a record of each of the patient’s providers, including pharmacies and medical equipment suppliers, is an essential step to understanding their current and future medical needs.

5. Routine Measurements

Another important part of the 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 risk for experiencing diminished cognitive abilities, which can negatively impact their quality of life and prevent them from caring for themselves. As a result, assessing the cognitive awareness of patients is key to keeping them healthy and safe. These assessments may include formal tools such as those provided by the National Institute of Aging, 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 many patients. There are many screening tools, such as those provided by the Substance Abuse and Mental Health Services Administration, that can assist providers as they work to identify these conditions so that they can be appropriately addressed.

8. Everyday Living and Safety Assessment

As patients age, they may lose the ability to complete activities that are 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 keeping 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 in the future or the present. This list should include both the risks themselves and the advantages and disadvantages of any treatment options.

10. Provide a Plan for the Future

The final step of the in-office portion of the Annual Wellness Visit is to use the gathered information to provide the patient guidance on how to maintain or improve their health. This process includes three important steps.

  1. The first is to provide them with a personalized patient plan that includes specific medical advice and strategies for addressing identified risks.
  2. The second piece is working with the patient to create an actionable screening schedule that provides the patient with a checklist for all recommended preventive medicine screenings over a five to ten year period.
  3. The final step, which is commonly missed, is to provide the patient with a physical copy of both the personalized patient plan and preventive screening schedule. 

Because creating the screening schedule and personalized plan can be extremely time-consuming, automating these steps with the use of a smart form can significantly reduce 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.

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. The specific rules regarding Annual Wellness Visits are complex, and so completing this process can be a time-consuming challenge for the practice staff. However, not completing the process correctly can result in either rejected claims or penalties incurred from being found non-compliant during audits. Either result means a loss of revenue for the medical practice.

12. Optional: Advanced Care Planning

Advanced care planning is optional but covered under Medicare at Annual Wellness Visits. 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 legally document. However, not all patients are comfortable talking about these topics, so advanced care planning should be done at the patient’s discretion.

Prevounce is designed to make sure that Medicare Annual Wellness Visits are beneficial for both patients and providers. Contact us to learn more about how our platform provides tools that make the AWV process simpler by automating pre-visit communication, verifying eligibility, supplying step-by-step walkthroughs, and providing coding & billing support so that wellness visits are completed and billed correctly every time.

Annual Wellness Visit Toolkit

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