An Ounce of Prevention
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.
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.
An essential element of the Medicare annual wellness visit (AWV) is the personalized prevention plan, sometimes referred to as the personalized prevention plan of service or PPPS. During the annual wellness visit, you are expected to create or update the patient's Medicare personalized prevention plan. This requirement is clearly stated, both in the regulations and AWV HCPCS codes descriptors, and yet it is often neglected. When the PPPS is overlooked, the potential ramifications are significant. Providers run the risk of experiencing claims denials, needing to return payments if shortcomings are discovered during audits, and reducing the value of the AWV and PPPS to patients.
Depression is usually a silent illness. Sufferers of depression often don’t realize that the symptoms they are experiencing are even related to depression. Patients may notice changes in sleeping habits, experience weight gain or unexpected weight loss, or have complaints of physical pain symptoms such as back pain or headaches. Given the diversity of depression symptoms, it is common for a patient to go to their primary care provider without realizing that their physical ailments may stem from a mental disorder such as depression. Due to this, primary care providers are well-positioned to be the first to recognize and diagnose depression in their patients.