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Performing Annual Wellness Visits Via Telephone

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Performing Annual Wellness Visits Via Telephone

by Daniel Tashnek

The annual wellness visit (AWV) is an important tool for providers to track and help manage the health and wellbeing of their Medicare patients. Social distancing is crucial to combat our current health crisis, but so is maintaining continuity of care with your most vulnerable patients. Fortunately, Medicare understands the importance of the AWV, and included it in it's initial §1135 waiver so that it can be performed entirely via telehealth on any Medicare beneficiary.

As of 4/30/20, Medicare further waived restrictions, and now allows Annual Wellness Visits to be conducted via audio-only telehealth (i.e. over the telephone) for the duration of the waiver.

 

Annual Wellness Visit Telehealth Requirements

Medicare considers the AWV to be a traditional “telemedicine” service, which normally comes with a bevy of restrictions on when it can be performed remotely. Despite this, Medicare has issued an emergency waiver that allows providers to furnish the entirety of the AWV over the phone for the duration of the Covid-19 crisis. 

All the normal service and documentation requirements of the in-person AWV remain the same for a telehealth AWV. Billing and coding use the same CPT and ICD codes, but you should add modifier -GT to signify it was performed via telehealth. During the crisis, Medicare is reimbursing telehealth AWVs at the same rate as it would if the visit was completed in-person.

Value of the Annual Wellness Visit During COVID-19

The AWV might not be the first service that comes to mind when you think of telehealth, but it is actually a powerful tool to use during the pandemic to benefit both patient health and practice revenue. The specific requirements included in the AWV essentially allows a practice to be reimbursed for reaching out to its most vulnerable patients to educate them about their health risks and the current crisis. Further, since the AWV can be furnished by clinical staff under supervision, it is a great way to use clinical staff who may otherwise be idle (or worse, furloughed) during the current crisis to grow a telemedicine program.

Unlike evaluation and management (E/M) visits and most other remote services, the AWV:

  • can be initiated by the provider/clinical staff by calling patients and letting them know their AWV is due;
  • is furnishable completely by clinical staff under supervision;
  • has no co-pay or co-insurance;
  • includes providing patient education on health risks (e.g., Covid-19); and
  • can be a significant source of needed practice revenue.

Vital Measurements in Telehealth/Phone AWVs

The vast majority of the AWV requirements can be easily performed via telehealth without adaptation, with one exception: collecting patient vital measurements.

The AWV requires the collection of patient height, weight, and blood pressure. The Centers for Medicare & Medicaid Services (CMS) has not specifically spoken on how best to collect measurements in this situation, but it is important that you have patients self-measure their vitals to the best of their ability. Let them know ahead of the visit that they should have their height and weight ready and should use a blood pressure cuff if they have one. Make sure to document each of these measurements as “patient reported.” If patients are unable to provide any of the measurements, it is important to document them as “unable to obtain from patient” as opposed to leaving them blank.

Adding Preventive Services to a Telephone AWV

Many Medicare preventive services can be conducted during a telehealth or telephone AWV to personalize and add value to the patient. These include:

  • Advance care planning (99497, 99498)
  • Alcohol screening/counseling (G0443, G0396)
  • Depression screening (G0444)
  • Cardio risk counseling (G0446)
  • Medical nutrition therapy
  • Diabetes self management training

You can see a full list of the services Medicare is allowing via telephone on the CMS website.

Maximizing the Benefits of the Annual Wellness Visit

The AWV is one of the best-positioned Medicare services to increase care coordination and management while maintaining the social distancing requirements of the current coronavirus pandemic. It creates an opportunity for care teams to identify patients who may need other services that the current crisis would have otherwise prevented them from receiving. A telehealth AWV also meets the requirements of an initiating visit to enroll a patient in chronic care management or remote patient monitoring.

During this time when delivering patient care and generating revenue is proving more difficult, providing the AWV via telehealth is a win-win service for patients and practices.

To learn how Prevounce helps practices easily add and deliver telehealth and remote patient monitoring services, schedule a demo of our platform.

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"It's usually covered by your health insurance, it doesn't take much time, and it's a great way to learn about your present and future health." So begins a Harvard Men's Health Watch article on why men need an annual wellness visit (AWV), but the sentiment expressed in the article applies to any Medicare beneficiary. The Medicare AWV is a valuable service for practices to offer their patients. It's valuable from a health and wellness perspective as the AWV can help physicians prevent disease and detect health issues faster. It's also valuable from a financial perspective as the AWV is reimbursed well, with practices receiving around $160 in average reimbursement per patient. This can be increased by performing, when appropriate, the many preventive services that can accompany an AWV. If you want to capture that revenue, you will need to know and understand the billing codes for the Medicare annual wellness visit.