An Ounce of Prevention
Medicare's annual wellness visit (AWV) has had a rocky ride since its introduction in 2010 and started in 2011 as part of the Affordable Care Act. As with many big healthcare changes, the new service was met with resistance and steeped in confusion, leading to terribly slow uptake and obstacles that still unjustly plague the service more than a decade later. When Medicare beneficiaries do not receive their AWV, this is not only a disservice to these patients, but practices and the healthcare system as a whole lose out on important and impactful benefits.
The results of a survey suggest that upwards of about 85% of Medicare annual wellness visits (AWV) may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS). The results should motivate providers to verify that the tools they are using during AWVs for Medicare patients effectively prompts them to ensure no required components are missed. If a required element is missed, the AWV can be considered non-compliant by an auditor, potentially leading to clawbacks and other penalties. In egregious and willful cases, a non-compliant practice could even face exclusion from Medicare or criminal liability.
Taking the time to prepare your Medicare patients for their annual wellness visit (AWV) can improve the overall experience. For patients, preparation helps to ensure the AWV meets their expectations, as well as feels less stressful and more productive. For you and your practice, prepared patients can expedite completion of the AWV in a manner that still meets patient needs and requirements.
"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 $150 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.
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.
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.
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.
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.
When you think of a pharmacist, you probably visualize the person in the lab coat behind the counter at your local pharmacy. Pharmacists are always there, ready to fill our prescriptions with precision, accuracy, and counsel us on adhering to our prescribed medication therapies. But could a pharmacist also be the Medicare annual wellness visit's (AWV's) — and the time-strapped provider's — superhero incognito?
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.