An Ounce of Prevention
This quick guide from Prevounce provides brief background information on the Affordable Care Act (ACA) and then identifies ACA preventive services and the CPT codes that correspond with each service. Along with the CPT codes, the guide identifies patient eligibility for each service. When listing all associated CPT codes would be impractical for a guide of this nature, we have provided a link to a webpage that provides the CPT codes you should use.
In this blog, we'll discuss what some practitioners consider to be a pesky service: the Medicare wellness visit, also referred to as the Medicare annual wellness visit or AWV. For various reasons, the very phrase "Medicare wellness visit" can instill a sense of loathing and dread. Confusing and unclear language concerning Medicare wellness visit guidelines can leave practitioners confused, potentially resulting in missed income opportunities for practices and missed preventive care opportunities for patients. However, the downsides of skipping the Medicare wellness visit are worse: harm to your bottom line and potentially harm to your patients if they do not receive this essential service elsewhere.
Prevounce Health, creators of the Prevounce Care Coordination Platform, congratulates Alexandra (Ola) Baczynski, the recipient of the first Prevounce Preventive Health Graduate Scholarship.
Prevounce Health, creators of the Prevounce Care Coordination Platform, congratulates Alyssa Johnston, the recipient of the first Prevounce Preventive Health Undergraduate Scholarship.
Update: The story below provided a brief overview of this breaking news. As of 2022, the information remains accurate. If you are interested in learning about noteworthy changes for 2022, view an on-demand webinar here.
In a recent blog, we described preventive services as "The Missing Link to Wellness." Research backs this claim up, showing that preventive services have the potential to dramatically reduce healthcare spending, improve economic output by billions of dollars, and save tens of thousands of lives. To help you better appreciate why preventive services should be offered by your practice and what to know before proceeding with adding such an offering, here is some of the essential information to understand about the preventive services Medicare covers.
For practitioners, preventive services, such as Medicare's annual wellness visit (AWV), are an important offering and should be a significant part of the day-to-day operations of every primary care practice. When furnished effectively and appropriately, preventive services are typically no cost to patients, encourage improved patient health and wellness outcomes, and increase practice revenue while decreasing practitioner risk — all while positively impacting our nation's out-of-control annual healthcare spending.
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.
You schedule a patient's first Medicare annual wellness visit (AWV). The patient comes into your practice, or perhaps you meet via telehealth. You furnish the AWV, seemingly checking all of the boxes necessary to deliver this critical yearly appointment that helps prevent illness and get your practice 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.
Research from leading expert organizations confirm time and time again the importance and effectiveness of preventive screenings and exams. Yet why are practitioners still having difficulty meeting this relatively inexpensive need for their patients? One argument is that payers place too many obstacles in the way, over-incentivizing reactive care and making the provision of preventive services difficult for practitioners to provide. Another argument is that patients may not be aware they are eligible to receive such services, often at no cost to them, and do not ask about what such services are available. A final argument is that, as a society, we are so focused on taking care of our over-abundance of chronically ill people that practitioners simply lack the time to flip the healthcare paradigm to a preventive care model. It's probably reasonable to assume that all the above play some role in the underutilization of preventive services. The Centers for Disease Control and Prevention (CDC) supports this notion, citing a lack in implementation on the behalf of practitioners.