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What Physicians Must Know: Medicare Annual Wellness Visit Template

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What Physicians Must Know: Medicare Annual Wellness Visit Template

by Lucy Lamboley

Preventive care is the way healthcare practitioners can identify and address any health risks in Medicare eligible patients. This was a primary motivator behind the introduction of Medicare’s Annual Wellness Visit (AWV) in 2011.

According to a 2017 study published in JAMA, the AWV has been rapidly adopted by Medicare beneficiaries, increasing from 7.5% to 15.6% between 2011 and 2014. Most notably, the practices more likely to adopt AWVs were very strategic about their implementation:

“…some physicians and health systems are incorporating strategies such as templates, workflows, or dedicated nonphysician health professionals to complete, document, and bill for AWVs.”

For providers, having a Medicare Annual Wellness Visit template is a crucial component of streamlining the process for both themselves and the patient. The provider can get a more comprehensive overview of their patient’s health in a shorter period, and the patient puts themselves in a better position to maximize their wellness. 

This article offers useful tips for setting up a usable and scalable AWV template. We want all patients to have access to the AWV, and all providers to go through the AWV process as easily and effortlessly as possible. 

You’ll discover how your practice will benefit, what the template should look like, and why your practice needs it – all with the ultimate goal of maintaining compliance and ensuring that reimbursement is going smoothly.

How Your Practice Benefits from Having a Medicare AWV Template

With an Annual Wellness Visit template, practices can streamline the entire process from start to finish. The template provides a systematic way for staff to follow-up with patients and the essential information patients need to know before their visit, along with reminders about what patients must bring to their appointment.

A Medicare Annual Wellness Visit template also allows practitioners to proactively document and organize the health risks of their patients. As a result, more Medicare patients are served in a shorter period without sacrificing the clinic’s bottom line, which means that additional income can be earned. This would be the natural outcome of a template that streamlines the entire process from start to finish.

Paper vs. Software Templating

While paper AWV templates are widely available and easy to use, they don’t always do an efficient job of capturing the entire picture. Paper templates cannot fully identify and track patients who are newly eligible for the Initial Preventive Physical Examination (IPPE), due for their AWV, or have questionable eligibility.

In addition, there are issues with paper templates regarding AWV documentation and billing. Paper templates are unable to generate customized reports for each patient and leave room for clinical staff to choose incorrect coding, which could result in denied or unpaid claims.

Alternatively, software templating often adds a cost to each AWV given. Whether or not this cost outweighs the increase in efficiency, reimbursement rate, and compliance depends mainly on your practice’s goals, patient base, and resources.

Regardless of your choice of format, there are important aspects that all Annual Wellness Visit templates need to meet Medicare requirements, while keeping the service efficient and effective.

How to Set Up a Medicare Annual Wellness Visit Template

While there are standard items to be covered in the Annual Wellness Visit, your practice may find additional health factors that are worth closer examination. The guide below is only an outline of the steps a clinical practice must ensure are in place for a Medicare Annual Wellness Visit.  

Eligibility 

  • Has the patient received an AWV in the past 12 months? If so, they are not eligible.
  • Is the patient receiving their AWV in the same year as their “Welcome to Medicare” visit? If so, they are not eligible.
  • Has the patient been under Medicare Part B coverage for over 12 months? If so, they are eligible.

Pre-AWV Preparation

  • Is the patient aware that the AWV is not the same thing as a routine physical examination? Have the differences been clearly explained to the patient? Do they fully understand this?
  • Have you asked the patient to bring as much of the following information as possible to the AWV:
    • A complete family history of health problems and complications (if any)
    • A comprehensive list of medications and supplements being taken (dosage, method of administration, frequency of dose)
    • A list of any other providers and physicians the patient is seeing
    • Medical records and immunization records (surgeries, injuries, hospital stays, etc.)
    • Has the patient scheduled their AWV on a set time and date?
    • Will follow-ups be provided closer to the date to remind patients of the AWV and what it entails?

AWV Examination 

  • Has the patient undergone all the minimum elements of a Health Risk Assessment (HRA)?
    • Functional ability - Is the patient able to carry out the necessary activities of daily living (ADLs)? These can include (but are not limited to) shopping, walking, putting their clothes on, and managing their medications.
    • Cognitive function – is the patient currently experiencing depression (or a mood disorder), experienced it in the past, and/or is exhibiting potential risk factors for depression?
    • Behavioral risks – Have any concerns or reports been raised by the patient’s family, friends, or caregivers regarding any abnormal behavior (alcohol misuse, functional status, fall risk, etc.)?
  • Have the following metrics been recorded: weight, height, BMI, waist circumference, blood pressure?
  • Has the patient’s risk factors been documented?
  • Do you have a current list of the patient’s medications and medical providers?
  • Has the patient provided you with a complete medical and family history?
  • Based on the results of the findings, has the patient been given appropriate advice and referrals to preventive services and programs that can reduce their specific health risks (interventions, screening tests, drug cessation, etc.)?
  • Has a personalized screening schedule been written out for the next 5-10 years that consists of preventive and early detection interventions?
  • Have you considered the patient for Medicare-covered services that are appropriate for the patient’s age?
    • If the patient is choosing or appointing a caregiver, have you given the patient the standard forms they must complete? Does the patient have multiple options? Have you asked the patient about their personal preferences for a caregiver?

Subsequent AWV Questionnaire (Performed 1 Year After the Initial AWV)

  • Has the patient’s Health Risk Assessment been fully updated (addressing psychosocial and behavioral risks, alongside ADLs?
  • Has the patient’s list of medical suppliers/providers and medications/supplements been updated?
  • Have you gone through the patient’s family and medical history to capture relevant changes?
  • Have you measured the patient’s weight, height, blood pressure, BMI, and waist circumference again?
  • Have you done another evaluation to assess cognitive impairment?
  • Have you evaluated the patient to identify any new (or existing) risk factors?
  • Have you updated the written screening schedule for the patient?
  • Are any new interventions underway (or being continued) to address the risk factors and conditions of the patient (if any)?
  • Has the patient been given personalized health advice and referrals to the appropriate services to maximize their wellness, based on their current state of health?

Billing 

  • Has the AWV been performed by a physician, qualified nonphysician practitioner, a medical professional, and/or a team of medical professionals (see this link to understand what entails each of these positions)? This will ensure Medicare Part B will cover the AWV.
  • If this is the initial AWV, make sure to use the HCPCS code “G0438” for billing.
  • If this is a subsequent AWV, make sure to use the HCPCS code “G0439” for billing.
  • NOTE: For both AWVs described, each includes a personalized prevention plan of service (PPS).
  • Have you notified your patient that any additional tests/services performed outside the boundaries of the AWV will require them to pay the Part B deductible and coinsurance (i.e., needing to treat or investigate a problem that already exists or has been discovered during the AWV? This also holds true if said tests/services are not covered under the preventive benefits, according to Medicare’s official government website.
  • Outside of this, the Medicare-eligible patient is not required to pay any coinsurance or deductible.

Why Does Your Practice Need a Medicare Annual Wellness Visit Template? 

Although the Medicare Annual Wellness Visit template listed above provides a general idea of the process, it is only a first step in streamlining the entire AWV from start to finish. Although the AWV is a potential source of new and ongoing revenue for a clinic, it must be successfully incorporated into the clinic’s existing patient management system. 

In addition to determining which staff members will be responsible for providing different aspects of the service, you must also decide how AWV implementation will take place.

For instance, the article “Medical Annual Wellness Visits Made Easier” from the American Academy of Family Physicians points out that to systematize your approach without overwhelming your practice, there must be a follow-up program in place to identify patients who are eligible for an AWV, reach out to said patients and conduct several calls afterward to gather the necessary information well in advance:

“A chart review or phone interview could be conducted soon after the visit is scheduled to gather a pre-visit history. More reliably, for purposes of payment, staff could use an electronic insurance inquiry or Internet eligibility service to verify eligibility for preventive services. Whatever the approach, having this information before the visit will help you to determine which preventive services are needed and whether the patient is eligible to have these paid for by Medicare.” 

This brings about several more questions that are essential to streamlining the entire process beyond a standalone Medicare Annual Wellness Visit template.

  • Can your electronic system automatically identify eligible patients and their AWV history?
  • Do you have a system in place that generates this list once a month/quarter?
  • Will your system identify patients who are soon to be eligible for an AWV?
  • Is there an electronic/automated option in your system for reaching out to patients?
  • Will your system ensure maximum compliance with HIPAA?
  • Does your AWV template allow you to increase the reimbursements your practice is eligible for efficiently?

How to Improve Your Medicare AWV Process 

If you are still struggling to determine how you can improve your implementation of AWVs in your clinic, non-profit HealthInsight has a series of 3 questions worth asking and revisiting regularly:

  1. What are we trying to accomplish?
  2. How will we know that a change is an improvement?
  3. What changes can we make that will result in improvement?

The best way to implement the Medicare Annual Wellness Visit template across your clinic would be through a single preventive care platform that compliments your existing system for maintaining electronic health records.

In addition to maintaining full compliance and more straightforward billing, it would streamline the AWV process to ensure patient visit times are reduced while gathering the critical medical information needed to provide more in-depth patient care. This platform would also offer some form of patient outreach automatically to integrate those who are eligible for an AWV in the near future.

But above all else, the solution needs to ultimately help patients achieve better overall health while saving precious money and time for physicians and their staff. If you are looking for an all-in-one solution that allows you to automate your practice’s workflow and significantly increase revenue without requiring additional work hours, Prevounce may be a good fit for your organization or office. If you’d like to learn more about our platform, book a meeting with us here.

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