If you came to this blog looking for instructions on setting up a Medicare annual wellness visit (AWV) template for your practice, you won't find that here. But don't go anywhere! We provide a link to a blog at the end of this piece that explains how to create an AWV template. The reason we put it at the end is because we think it's important to explain a few of the most significant reasons why your practice should not default to using a paper template or rigid electronic template (e.g., fillable PDF). Our guidance is largely centered around the fact that at its core, the AWV is a fairly complex set of requirements that have the potential to lead to compliance pitfalls.
Usage of a paper or rigid electronic template contributes to suboptimal efficiency and time management, which ultimately translates into decreased productivity and higher costs associated with furnishing the AWV. Here are three examples of when such templates come up short.
Medicare has very specific rules concerning when a patient is eligible for preventive and wellness services like the AWV. In the case of the AWV, the primary eligibility requirements concern the timing of the appointment compared to other service dates. Medicare only covers AWV appointments when patients have been enrolled in Medicare for more than 12 months and has not already received their initial preventive physical examination (IPPE), also known as the "Welcome to Medicare" preventive visit, in the preceding 12 months. Verifying beneficiary eligibility is an essential step in the AWV process and one that helps protects your practice and patients from financial burdens caused by rejected claims. This is only compounded by other common services that have their co-payment waived only when done concurrently with a valid AWV.
When the AVW is not automated, which is not possible when using a paper or rigid electronic template, determining whether a patient is eligible for an initial or subsequent AWV will be a more time-consuming and inefficient process — one that is only made more difficult if the patient is new to a practice. Manual verification is typically completed via phone call, through a Medicare administrative contractor (MAC) portal, or clearinghouse. If there are any issues encountered when performing manual verification, staff will need to continue following up until verification is determined, wasting valuable time that could be saved via automation.
Your practice will need to perform the same verification process for any other preventive services you might advise patients receive in conjunction with their annual wellness visit. The American Academy of Family Physicians recommends practices leverage a more automated approach to verification, noting, "More reliably, for purposes of payment, staff could use an electronic insurance inquiry or Internet eligibility service to verify eligibility for preventive services."
There are numerous components to initial and subsequent annual wellness visits — and then numerous elements within those components. The Centers for Medicare & Medicaid Services lists all of these components and elements. These must be documented for a practice to properly complete the AWV. Recording this information in ink or needing to type all of it in to form fields is not only inefficient but tiresome. Documenting many of these components becomes significantly easier to perform — and with a higher degree of accuracy — with quick automated access to patient information already captured in an electronic medical record (EMR) system. Such access eliminates the need to reinput existing information or look through the patient record for pertinent history.
Such data sharing goes in the other direction as well. You do not want a patient to share important information that is captured in the AWV and not have these details update correctly in the EMR just because the information is entered into a discrete form or template.
If you choose to use a template, your practice will lose out on additional efficiencies associated with an annual wellness visit software solution. For example, software can often expedite and improve the accuracy of pre-visit gathering of patient information, completion of the health risk assessment (HRA) and personalized prevention plan of service (PPPS), and evaluation of patient health risks (more on this below). This helps practices deliver more personalized care, received timely reimbursements for services rendered, and reduces audit risk.
While furnishing of the AWV can involve clinical staff (with physician oversight), usage of a paper or rigid electronic template makes doing so more difficult. As part of the AWV, patients should receive specific advice and referrals to preventive services and programs that can reduce their health risks. For example, if a patient's body mass index (BMI) is high, the plan should include recommendations that can help bring the BMI down, such as dietary changes or counseling. If patients use tobacco, recommendations would include cessation counseling. Note: These are simplified examples. You can view a more complex example concerning the recommendations for colon cancer screening here.
A physician will likely have the knowledge to fill in this information, but clinical staff — without such specific training — may not. This means that providing advice would initially require additional physician involvement or staff research and eventually require staff members to undergo training if a practice wanted them to take on more of an independent role in completing the documentation. AWV software leverages algorithms to guide staff in making appropriate care plan decisions without further involving physicians.
Now consider the need for patients to receive a personalized screening schedule for the next 5-10 years that consists of preventive and early detection interventions. If physicians wanted to task staff members with completing this personalized schedule in a paper or rigid AWV template, they would likely require training on the available services and referral options. The same is true for considering patients for Medicare-covered services appropriate for their age. An AWV software platform can utilize validated logic to recommend preventive services that should be put on the patient’s five-year schedule and which services are recommended to be performed on the patient during the same visit in real time in response to the patient’s answers during the AWV. This sort of preventive service decision support allows clinical staff to provide and schedule preventives while permitting physician oversight and override in situations of an unusual patient situation.
A significant aspect of the annual wellness visit is the creation or updating of a patient's personalized prevention plan of service (PPPS). This plan is supposed to be based on the recommendations to reduce health risks and scheduling of services. To properly complete the PPPS using a paper or rigid template will require the significant clinical knowledge previously discussed. AWV software can simplify the health risk assessment (HRA), giving practices the detailed information they need to ask more targeted questions of patients that can help personalize the PPPS. Some platforms even automate the plan and scheduling of preventive services.
As mentioned earlier, to appropriately complete the Medicare annual wellness visit requires practices to carefully follow an intricate, multifaceted list of requirements. A single mistake or oversight can result in rejected claims and/or penalties incurred from a practice being found non-compliant during audits, in addition to the patient not getting the benefit of the service.
By using a paper or rigid electronic template for documentation and billing, you are unable to easily generate customized reports for each patient. This opens the door to staff choosing incorrect coding, which can lead to the aforementioned denials and penalties. With an electronic solution, you may gain access to automatically generated smart superbills that consider all known coding variations and your practice's historical reimbursement data, increasing the likelihood of accurate completion of documentation and receipt of appropriate payments.
We hope this blog has helped you gain a better understanding of the potential shortcomings of using a paper or rigid electronic template to furnish the annual wellness visit. If you still would like assistance with setting up an AWV template, read this blog. If you want to learn how Prevounce platform helps providers streamline creation and completion of a compliant AWV with PPPS, schedule a live demo now!