An Ounce of Prevention
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).
Some areas of healthcare have evolved at lightning speed over these past several years, with the COVID-19 pandemic and its far-reaching impact accelerating progress with relative ease. Adopted just a few years prior to the public health emergency's onset, chronic care management (CCM) is now solidified as a service and emerging care model — one that is bridging distance gaps and helping chronic disease patients reach and sustain better health for longer. Yet adoption has been slower than one might expect for a service with so many patient care benefits. Is the near-sighted perceived cost of this multifaceted solution deterring patients from taking advantage of it? Before we answer this question, and provide some reasons why patients and practitioners should fully embrace chronic care management, let's gain a better understanding of CCM.
Documentation Requirements for the Medicare Annual Wellness Visit The documentation requirements for the Medicare annual wellness visit (AWV) serve multiple purposes. Most importantly, documentation is critical to maximizing the value of the Medicare AWV to patients. As AARP notes, the Medicare AWV is "… designed to promote the use of preventive care, identify health risks, and plan for future healthcare needs." In addition, the Medicare AWV is an opportunity for patients to meet with providers who can also deliver or schedule preventive services, which we discuss in this blog post that shares HCPCS and CPT codes for billing the AWV and supplementary preventive services.
One of the silver linings of the COVID-19 pandemic was the increased adoption of virtual healthcare services and delivery systems. This includes remote patient monitoring, or RPM. Remote patient monitoring was a concept foreign to most individuals before the health crisis, but that is rapidly changing as providers increasingly adopt the service and enroll their patients. Yet many people still lack a firm understanding of remote patient monitoring, so we thought it would be helpful to dedicate a blog that focuses on the definition of RPM and contrasts the concept of remote patient monitoring with other terms frequently associated with it.
You schedule a patient's first Medicare annual wellness visit (AWV). The patient comes into your organization, or perhaps you meet via telehealth. You furnish the AWV, seemingly checking all the boxes necessary to deliver this critical yearly appointment that helps prevent illness and get your organization paid. And yet a few weeks after submitting your claim to Medicare for the service, it's denied. The reason: You incorrectly used HCPCS code G0438. Denials can lead to increased days in accounts receivable, write-off rates, and overall cost to collect, among other headaches. A study revealed thatmany AWVs conducted and billed may fail to meet compliance requirements set forth by CMS, which can trigger denials or more serious ramifications. If you want to better ensure that your annual wellness visit claims are not denied, you must know how to properly code them. In this piece, we provide you with the HCPCS codes you need to use for annual wellness visits. We also share guidance that should help reduce the likelihood that your organization will experience denials associated with this service and another service commonly associated with the AWV that may trip you up: the initial preventive physician examination (IPPE).
The importance of using preventive medicine to improve the health and ultimately lives of patients is widely recognized. The Medicare annual wellness visit (AWV) plays an important role in helping Medicare beneficiaries stay current with their health and take actions that can prevent illness and reduce risk. An essential piece of the process required to ensure offering and providing preventive services remains financially viable is for organizations to complete the Medicare annual wellness visit reimbursement coding process accurately. Doing so can help ensure providers receive their earned reimbursements and protect them against possible penalties they might incur from failed coding audits. We know some organizations struggle with meeting compliance requirements set forth by the Centers for Medicare & Medicaid Services. In this blog post, we take a look at what's required for compliant AWV coding. While this is by no means a comprehensive guide to Medicare annual wellness visit reimbursement, it provides organizations with information that can assist them in avoiding some of the most common AWV coding mistakes that result in rejected claims, lost revenue, or failed audits — all of which can be mitigated when using Prevounce software.
Over the past several years, the stars have aligned for remote patient monitoring (RPM). An overhaul of the RPM CPT codes (99453, 99454, 99457, and 99458) made RPM into a lucrative Medicare management program. Medicare is making it easier for organizations to provide RPM services, and private-payer coverage of RPM is growing. The COVID-19 pandemic helped drive the adoption and use of remote patient monitoring devices in healthcare. Finally, a rapidly growing number of patients are interested in virtual care services like RPM, their interest largely fueled by the public health emergency. These factors and others make it an optimal time to consider launching or growing RPM programs — especially when RPM is included in a more comprehensive care management program. Another motivating factor for organizations is they now have many choices of remote patient monitoring medical devices to offer patients and include in their programs. From these options, organizations can select the devices that will best meet the short- and long-term care needs of their patients and maximize RPM programs’ revenue potential.
If you've come to read this blog post, you're presumably looking for the rules you should be following to perform proper chronic care management (CCM) billing and coding. That's good. While the federal government has been increasingly supportive of care management programs, they are also more closely scrutinizing CCM reimbursement by auditing instances and causes of overpayment associated with incorrect billing of the service.
Over the last few years, remote patient monitoring (RPM), also referred to as remote physiologic monitoring, became one of the more lucrative Medicare care management programs. Using average 2023 RPM reimbursement rates, if 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, that will generate annual reimbursement exceeding $115,000. We can largely thank the overhaul of RPM CPT codes in 2020 for such generous reimbursement.
It's no secret that technology has vastly improved healthcare. In just the past few years, we've seen telehealth essentially transform the delivery of care. From increased access and improved patient outcomes to reductions in care costs, telehealth technology like remote patient monitoring (RPM) is driving healthcare evolution, helping practitioners improve the ways in which we interact with patients every day. Thanks to the ingenuity and creativity of technology thought leaders and innovators, we can now reach more people than ever before, including previously difficult to access rural patients, and do so more effectively and efficiently.