An Ounce of Prevention
When COVID-19 hit, it hit hard — mentally, physically, and financially. The initial impact left by the virus was far reaching, wreaking havoc on the health and financial wellness of nearly every American. Among healthcare providers, one of the groups that took a big hit early on was primary care providers (PCPs). COVID-19 risk, fear, and uncertainty contributed to the lockdowns that directly impacted PCPs' bottom lines and productivity. They were forced to postpone what were deemed unnecessary patient visits, including the Medicare annual wellness visit (AWV), and scramble to piece together creative pathways for safe, socially distanced care that could also generate enough of a continuous stream of incoming revenue to keep practices afloat amid the pandemic's storm.
From its creation in 1984, the U.S. Preventive Services Task Force (USPSTF) has been a significant influence in healthcare, helping to recommend and determine the most beneficial and effective clinical preventive services. With the goal of creating a positive impact on the health of all Americans, the Preventive Services Task Force reviews and updates existing clinical preventive service guidelines and evaluates new preventive service recommendations. Through the diligent work of USPSTF, practitioners are armed with the most reliable and current clinical prevention tactics available, helping them to create a positive and lasting impact on the health and wellness of their patients. Read on to learn about six things you should know about the Preventive Services Task Force.
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 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.
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.