Annual Wellness Visit - Rural Health ClinicCreating a personalized PREVENTION and treatment plan is an essential yet often overlooked health service. The Centers for Medicare and Medicaid Services (CMS) has acknowledged this care gap and has created a series of wellness benefits that emphasize the importance of providing these services annually for every patient. Caravan Health believes these are an optimal opportunity to engage with patients to improve patient experience, outcomes and cost of care.

Utilize Lightbeam, EHR, client portal or MAC to identify patients eligible for Annual Wellness Visit or IPPE.

Call identified patients to explain need and reason for visit.

Explain services, team roles, purpose and benefits of visit prior to proceeding with services.

Verify past medical & family history, all current prescribed and OTC medications, Vaccination & Prevention status, treating providers.

Review appropriate coding and identify any HCC gaps that need to be addressed by provider.

Take time to review and document all ACO and organizational quality metrics in the appropriate location within EHR.

Confirm patient’s readiness for ACP and discuss the patient’s wishes and preferences for medical treatment.

Provider closes visit and/or proceeds to appropriate E&M visit- reviews and interprets screenings, PMHx, HCC, Meds, prevention, & orders necessary services.

Determine need for Chronic Care Management or other care coordination services.

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Discuss and perform additional health risk screenings- PHQ-9, Mini-Cog, Timed Up-and-Go, tobacco and other applicable SBIRT screenings.

W O R K F L O W

PatientEligibility

ReachOut

Engage

Verify MedicalHistory

Note ComplexityCoding

Tick theBox

Initiate AdvanceCare Planning (ACP)

OverseeingProvider Visit

Need for OngoingCare Coordination

EvaluateAdditional Risks

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What is an Annual Wellness Visit? Coding, Billing &Reimbursement Specifics

Who Can Perform the AnnualWellness Visit?

Medicare covers two separate types of preventive visits. Both services provide a valuable opportunity to establish the foundation for team-based primary care.

Initial Preventive Physical Exam (IPPE)• An introductory visit for new Medicare patients that

can only be provided within the first 12 months thepatient receives Part B benefits.

• Includes a physical exam.

Annual Wellness Visits (AWV)• An annual benefit for Medicare patients covered under

Part B.• This visit is covered once every 12 months who have

not gotten either an IPPE or an AWV within the past 12months.

• Medicare pays for the Initial AWV once per lifetime andpays for one Subsequent AWV per year thereaftervisits). An IPPE is not required for an Annual WellnessVisit.

• Does not include a physician exam.

Initial Preventive Physical Examination (IPPE):• Reported with HCPCS code G0402.• A medical or mental health RHC visit on the same is separately

reimbursed.• When an EKG (G0405) is performed in an independent RHC, the

professional component of the diagnostic test is considered to bepart of the RHC visit. The technical component of the EKG (G0404)can be billed to Part B on a CMS-1500. If an EKG is performed at aprovider-based RHC, the technical component can be billed by themain provider on their usual outpatient type of bill (e.g., TOB 851TOB 131). Neither the professional and technical components of theEKG, waive the deductible or coinsurance.

Annual Wellness Visit (AWV):• Use HCPCS codes G0438 (AWV, Initial) and G0439 (AWV, Subsequent).• The AWV can be billed as a stand-alone visit if it is the only medical

service provided by a RHC practitioner and will be paid at theAll-Inclusive Rate (AIR).

• You should report codes for all pertinent active reviewed diagnosiscodes from the beneficiary’s health history when submitting a claim.

Separate same day E/M Services:• If the AWV is furnished on the same day as another medical visit, it is

included in the AIR for the medical visit.• Exception: IPPE CAN be billed on same day as E&M visit.• The cost of staff to provide these visits can be added to the cost

report.

For both services:• All components of the visit must be provided prior to submitting a

claim for the service.• The beneficiary coinsurance is waived.• The cost of staff to provide these visits can be will be included in the

cost report.

Advance Care Planning (ACP):• You can provide the ACP at the time of the AWV, at the beneficiary’s

discretion. ACP is reported with CPT® codes 99497 (first 30 min.).• The beneficiary coinsurance and deductible are waived for both AWV

and ACP services when provided on the same calendar day. • ACP can be billed as a stand-alone visit if it is the only medical service

provided on a day by a RHC practitioner and will be paid at the AIR.• If ACP is billed on the same day as another billable medical visit, only

one visit will be paid, and coinsurance anddeductible would apply.

• Both the AWV and ACP can be reported on the cost report if theyrepresent a cost to the RHC. RHCs can only bill the AIR but can addcost of staff to do work to cost report for reimbursement.

• You must report a diagnosis code that is consistent with thebeneficiary’s exam when submitting a claim for ACP.

Annual Wellness Visit Components– Initial AWV and IPPE

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Initial Preventive Physical Exam(IPPE):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nursespecialist).

Annual Wellness Visit (AWV):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nursespecialist); or

• Medical professional (including a health educator,registered dietitian, nutrition professional, or otherlicensed practitioner); or a team of such medicalprofessionals who are working under the directsupervision of a physician.

Talk with your Caravan HealthImprovement Manager, Clinical Leaderor visit the Medicare Learning Networkfor more information.1. Perform a Health Risk Assessment (AWV only)

2. Assess Cognitive Function (AWV only)3. Establish a list of current providers and suppliers (AWV only)4. Complete review of beneficiary & medical history5. Measure height, weight, blood pressure, BMI, and (pertinent physical & visual acuity for IPPE only.)6. Review the beneficiary & potential risk for factors for depression, including current or past history

of depression or other mood disorders with appropriate screening tool7. Review the beneficiary & functional ability and level of safety (ADLs, Fall Risk, Hearing Impairment, Home Safety)8. Establish an appropriate written screening schedule for the beneficiary such as a checklist for the next 5-10 years9. Establish a list of beneficiary risk factors and condition for which primary,

secondary, or tertiary interventions are recommended or underway10. Provide the beneficiary with personalized health advice providing appropriate

referrals for health education, counseling or other necessary services11. Furnish, at the beneficiary’s discretion, advance care planning services (ACP)

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