An Ounce of Prevention
Over the past decade, remote patient monitoring, or RPM, has been slowly gaining momentum. 2020 was already expected to be a big year for RPM, but “big year” turned out to be an understatement. The COVID-19 pandemic has spurred RPM into the spotlight, positioning it to become an essential health-care delivery service, embraced by providers, payers, and patients. Even with all the publicity, there has been a bit of confusion about what types of care fall into RPM. Depending on the article you read, “Remote patient monitoring” can be used as a general term, a CPT coded service, or as a term of art. We wrote this fact sheet to help clarify things for both providers and patients alike.
When you conduct an online search for information about the Medicare annual wellness visit or AWV, one of the first resources you will find is an independent reference tool called Medicare Interactive. Its description of the AWV is as follows: "The annual wellness visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan." Going by this definition, one might believe that the answer to the question "Who can perform the Medicare annual wellness visit?" is a PCP. End of story, right? Far from it.
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.
Anyone who works with Medicare on a regular basis understands how often the Centers for Medicare & Medicaid Services (CMS) seemingly changes its rules. Keeping up with new and ever-evolving policies can be challenging, but there are a few simple ways to stay current. Look for updates quarterly on the CMS website and follow the Prevounce blog for important and timely coverage of Medicare topics, especially those that matter the most to you, your practice, and your patients.
Preventive care is the way healthcare practitioners can identify and address any health risks in Medicare eligible patients. This was a primary motivator behind the introduction of Medicare’s Annual Wellness Visit (AWV) in 2011.
One of the most important steps in a Medicare Annual Wellness Visit, or any preventive health screening, is the completion of a health risk assessment. These questionnaires give providers valuable information as they strive to make informed decisions about the potential health needs of individual patients. However, few patients are enthusiastic about completing these forms and may view them as a tedious chore instead of an essential step toward remaining healthy.
As the healthcare industry continues to look for ways to improve patient health while also controlling the ever-rising cost of quality healthcare, preventive screening has become an increasingly important topic.