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Copyright 2015. All Rights Reserved. www.medicareawv.info
What is it and why does it matter to my practice?
MEDICAREANNUAL WELLNESS VISIT
Charles P. Smith, RN BSNCEO, Innovative Health Media
Copyright 2015. All Rights Reserved. www.medicareawv.info
History of the Annual Wellness Visit (AWV)
Funded by the 2010 Affordable Care Act
Started shift to preventive care
Increased reimbursement potential for primary care providers (PCP)
Medicare began reimbursing in 2011, and patient has NO COPAY
Copyright 2015. All Rights Reserved. www.medicareawv.info
Who is eligible for an AWV?
Within first 12 months of Medicare coverage
Months 12-24 of Medicare coverage
Months 24+ of Medicare coverage
HCPCS Code
IPPE (Welcome to Medicare Exam) X G0402
Initial AWV X (must be at least 12
mo after IPPE)
X(if no previous AWV
performed)G0438
Subsequent AWV X (must be at least 11 months, 1 day after
Initial AWV)
X (must be at least 11 months, 1 day after
previous AWV)
G0439
Any patient with Medicare Part B or Medicare Advantage (Part C) is eligible as shown in the table below:
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The reimbursement rate is dependent on your geographic area, but in 2015 the National Payment Amount for the IPPE and AWV were:
IPPE (G0402) : $168.89 Initial AWV (G0438) : $174.28 Subsequent AWV (G0439) : $117.86
What is the reimbursement rate?
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Can perform and bill under physician NPIAny place, anywhere
Can perform and bill under own NPI Any place, anywhere
Can perform entire AWV under “direct supervision” of the billing physician
Can collect data but a provider must complete visit and bill under provider’s NPI
Physician XNurse Practitioner X (85% reimb rate)Physician Assistant X (85% reimb rate)RN/LPN XMedical Assistant X
Who can perform the AWV in my practice?
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Annual Physical Exam “Sick visit”
WHAT IT IS NOT
“Well Visit”, designed for a discussion with your patient
Review of your patients history, meds, immunizations, providers
Health Risk Assessment Detection of potential issues not
found in normal physical exam Creation of a preventive care plan
WHAT IT IS
What is the Annual Wellness Visit?
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Patient will: Learn about their own health Receive a written preventive plan Receive a written eligibility
schedule of free screenings for next 5-10 years
Obtain additional services if needed
Practice will: Obtain a more thorough history
on your patients Increase your reimbursement
from Medicare Discover needs for additional
services Improve quality measures for
MIPS and PQRS
Benefits to your practice and patients
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Medicare has laid out very specific requirements that must be met in order to be reimbursed for the AWV.
General Medicare requirements can be found at: www.cms.gov
For more details, visit our website at: www.medicareawv.info
What are the specific requirements of the AWV?
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Failure to meet the Medicare requirements will put you at risk in an audit or if a patient complains.
Medicare audits are performed by contractors that are paid based on how much they recover, so they will be looking at details.
You must maintain an adequate audit trail to show you are meeting the requirements.
The templates in most EHRs do not meet all the requirements.
What are my audit risks?
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Evidence that you reviewed the patients history (beyond what was already in your EHR)
Review and document ALL of the
patients medications including OTC, herbal supplements, vitamins and prescribed by other providers
Common audit issues to be aware of:
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Develop a list with contact information for all of the patients providers including pharmacies, dentists, home health agencies, durable equipment providers, chiropractors, and other specialists
Common audit issues to be aware of:
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Provide a written Personal Preventive Plan to the patient which must include eligibility dates for the Medicare free preventive screenings for the next 5-10 years.
Common audit issues to be aware of:
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Utilize a consistent, reliable system that meets the requirements for every person receiving an AWV
Keep a copy of the Health Risk Assessment in your records
How to minimize your risk
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Make sure the patient gets a printed PPPS and keep a copy in your records
If you haven’t been meeting the requirements, notify Medicare and fix it immediately or risk the consequences.
How to minimize your risk
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There are many electronic AWV systems available, here are a few things to look for: Systems vary from easy to complex Some may try to upsell you additional services. Decide what you need, and don’t pay for extras that will just confuse your staff
and patients. Very few EHRs allow interactivity between other vendors and their EHR without a
hefty fee structure. Look for systems that include full training and support in the initial price.
Just search for: electronic AWV, AWV templates, or e-AWV
Electronic AWV Systems
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If you have any questions I have not addressed, please check our website at www.medicareawv.info , or contact
me directly at chuck@medicareawv.info
THANK YOU FOR YOUR INTEREST
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