Medicare Annual Wellness Visits for Primary Care
In this weeks video, we talk about annual wellness visits for Medicare patients.
You will learn:
- How Wellness Visits came to exist
- How wellness visits can increase the revenue of your practice while improving the quality of care you provide to your patients.
- The difference between a wellness visit and a physical exam
- … and much more.
M Force shows you how to prosper in your practice by doing the right thing.
Make sure you watch to the very end of the video where we reveal how you can make thousands from Medicare simply by doing the things you’re probably already doing in your practice.
*And don’t try just skipping to the end. It won’t make any sense unless you get the whole story. So, let’s get started…
I’m Penny, a medical assistant and manager of three primary care offices in Franklin County GA.
Before I go into all this seemingly complicated mess of medical jargon and procedures, let me tell you: We are old fashioned. In this part of Georgia, we have a small town feel. We’re like a family. We love it; and we thrive on giving those communities the care and personal attention they deserve. But, as you can probably imagine, new ideas and new ways of doing things are a bit more difficult to get moving in this neck of the woods. However, once we really understood the benefit of the information I’m about to share, we were willing to jump through all the hoops necessary to make it work. Not only for us but for the benefit of the communities we serve. We think you might feel the same way after this video.
ABOUT WELLNESS VISITS
- Wellness Visits have been around since 2011
- We didn’t learn about them until 2014 when we joined an Accountable Care Organization
- Later, we’ll talk more about Accountable Care Organizations and how they can help you… but for now, let’s focus on where these Annual Wellness Visits came from.
- Annual Wellness Visits came out of something called the Patient Protection Affordable Care Act, a law signed in 2010 and delivered through the Center of Medical Services (or CMS for short). The CMS gives instructions for the new rules of Medicare. These rules are published through something else called the U.S. Federal Register.
THE U.S. FEDERAL REGISTER
Have you read the U.S. Federal Register? I know I hadn’t. It’s a big book of medical and legal blabber that’s not much fun to read. But, once we did, we learned a lot about how to prosper with Medicare by doing the right thing. Everyone should know about the Federal Register. Well… only everyone interested in increasing the quality of care for patients while increasing revenue for the practice at the same time. Besides the U.S. Federal Register, the Center of Medical Services is a great source of all kinds of information. Let’s look at an example.
MONEY LEFT ON THE TABLE
One of the advantages of being in an ACO is that the ACO receives data from CMS, analyzes it and gives the data to each member in a way that makes sense. Georgia Clinics is a family of primary care medical offices who were also members of our Accountable Care Organization. The CMS had assigned 1,183 patients to Georgia Clinics. But Georgia Clinics had only performed Annual Wellness Visits on 80 of those patients. If Georgia Clinics would have done the other 1,103 Annual Wellness Visits, they would have made an additional $170,510 while better serving their Medicare patients. Georgia Clinics was already doing a great job but the guidance of our Accountable Care Organization opened their eyes, teaching them about Annual Wellness Visits and other Medicare things that would allow them to improve. They have transformed their primary care clinics and now are doing 122 AWV per month to make up for the missed opportunities.
This case study sure got our attention. We definitely didn’t want to be missing out on that kind of revenue. That revenue could save our practice from being bought out by a hospital That revenue could improve our practice, allowing us to afford better equipment, more employees or even more space. Our patients would not only benefit from all of those things but also from the free preventative care visits that Medicare pays for.
MORE LESSONS FROM OUR ACO
AWV VS. APE
Annual wellness visits are not the same as annual physical exams. APE are coded as 99214 or 930215 for established patients and 99203 to 99205 for new patients. AWV are coded differently. To have prosperity from doing the right thing, you must have the codes right.
Looking at the data from this 2012 John A. Hartford Foundation report, you can tell we’re not the only ones who left money on the table. 74% of patients did not complete a wellness exam and 54% of patients hadn’t even heard of the annual wellness exams. Data from our Accountable Care Organization also confirms what is shown in this study.
STEPS FROM OUR ACO FOR MAXIMIZING ANNUAL WELLNESS VISITS
1) Identify all Medicare patients, including ACO, advantage or HMO, in your practice.
2) Check eligibility on all these patients using the CAHABA website.
* If you want to learn how to check eligibility, go to the M Force Youtube channel and view the Medicare Eligibility video.
3) While checking the eligibility, look for codes G0438 and/or G0439 code to see when or if patients have had Annual Wellness Visits done previously. G0402 (IPPE or welcome to Medicare visit) won’t be found under the eligibility information.
4) Schedule patients for their AWV when they are DUE.
- Example: If the eligibility tool says they are due in 11/01/2015, schedule their next AWV any day in November 2015.
5) During the visit, follow the AWV template to meet the quality measures for AWV.
6) Finally, bill the appropriate G code: G0438 or G0439
- (If it is the patient’s “Welcome to Medicare” visit, use G0402.)
MORE ON SCHEDULING ANNUAL WELLNESS VISITS
Schedulers play an important role in transforming the primary care office. These visits have to be scheduled at very particular times. More specifically:
- Initial Preventive Physical Exam needs to be scheduled within 12 months of the patient receiving medicare coverage
- The first AWV needs to be scheduled 12 months after the initial preventive physical exam.
- Subsequent AWV should be scheduled 11 month after that
- For example: A patient who got enrolled in Medicare on may 1st, but had their Initial Preventive Physical Exam on oct 1st, would have their Initial AWV on oct 2 the next year and a subsequent AWV on nov 3 the year after that
3 T’s TO SUCCESS WITH ANNUAL WELLNESS VISITS
- Team (employees)
- Teaching (patient education)
Patients need time to collect information and fill out a Health Risk Assessment (HRA). Our patients have to provide all of their vaccination history including the dates. Also, the patients have to list all the doctors and DME companies, including names and addresses, that have provided them with any medical services.
SUCCESS WITH PATIENT PARTICIPATION
- You need a good scheduler, someone who is good on the phone. For us, we found that someone with a sweet voice and nice country tone worked well.
- You need medical assistants who can get all of the right information into the medical records.
- You need physicians, physician’s assistants and nurse practitioners who can put together and create assessments, order test , counsel patients, and make sure all records are complete.
- You also need qualified personnel who can follow up on all orders to make sure all plans from the doctor are completed and documented before the next Annual Wellness Visits are scheduled
Now that may sound like a lot of extra work and expense but, trust me, it’s all worth it. This isn’t a theory. It’s what we’ve done. It’s what others in our Accountable Care Organization have done; and it works.
When we were doing AWV we noticed that many of our patients were seeing more than 5 specialist and we (nor the patient) had any idea why. We had almost no records from the patient or anyone else. We had to put a lot of work into contacting those specialists and even more work into getting our own patient’s records from them. Can you believe that? Our patients have buckets full of medications and had no idea who prescribed what. They filled prescription and were taking medications without knowledge of cost , side effects, or overall effectiveness.
Our patients had been admitted to multiple hospitals and, again, we have no information from these hospitals about the reason for admission, the treatments, or test performed. In many cases, the patients failed to notify the hospitals who their primary care doctor was. This is one of the reasons why patient education is so important. I was shocked by all this new information from our Accountable Care Organization and really did not like what was happening to our patients. Medicare knows that primary care physicians will take better care of their own patients when they are empowered to do so. They WANT you to take back control and they are paying you to do it.
We lost patients to specialist. Can you believe that if a specialist sees your patient more often than you, AND you have not performed an Annual Wellness Visit on that patient, Medicare will assign that patient to the specialist as their primary care physician? That’s not good for you or your patients
Medicare is paying for preventative care, at no cost to the patient. It starts with Annual Wellness Visits but there are many more preventative services that you may already be doing which Medicare will pay for. Now, if you do not do the preventive services, which are already paid for, or do not code them correctly, it’s a loss situation. Your practice loses money and, more importantly, your patients lose access to free preventative care.
* Here’s a tip!
There’s a book from the United States Preventive Service Task Force, or USPSTF for short, that lists all of the preventative services you could be providing. We keep a copy of that book in our office and are now doing most of the preventative services listed in that book. That makes us look good, brings us more revenue, AND our patients get the free preventive care they deserve, I call that a win/win situation for all. These preventative services can add up to an extra $200/yr for each medicare patient. How much would that add up to for your practice?
PREVENTATIVE SERVICE EXAMPLES
YOU MAY ALREADY BE DOING SOME OF THESE SO, WHY NOT LET MEDICARE PAY YOU FOR IT?
- Asking patients about alcohol use and advising them to either stop or decrease consumption
- Advising patients to stop smoking
- Checking patients for depression
- Advising patients to take aspirin if their risk of CVD is high
- Advising patients to lose weight
Did you know Medicare will also pay for a free screening for the following things?
- Colorectal Cancer — several options
- Pap Tests
- Pelvic Exams
- Alcohol Misuse
- Sexually Transmitted Diseases
- Prostate — DRE/PSA
DID YOU KNOW THAT MEDICARE WILL PAY FOR VACCINATIONS?
- Hepatitis B
- Herpes Zoster Vaccine
We want all our patient vaccinations updated and documented in our charts. We also put an alert in our EMR when the next vaccination is due.
DID YOU KNOW THAT MEDICARE WILL PAY FOR THE FOLLOWING CONSULTATIONS?
- Diabetes Self-Management Training
- Medical Nutrition Therapy
- Diabetes, renal disease/kidney transplant
- Intensive Behavioral Therapy for CV Disease
That’s a lot of FREE care for your patients and a lot of extra revenue for your practice that I’m sure you could put to good use. Now it’s up to you to take up the challenge. I believe it’s time for primary care to regain leadership in providing coordinated, cost effective healthcare to Medicare patients.
How can you explain the fact that some seniors with multiple chronic conditions see an average of 14 different doctors and fill 50 prescriptions a year? It’s more expensive and more dangerous for the patients.
We can reduce medical error and save the lives of our patients by transforming our practices with a new way of thinking where we, again, start coordinating the care of our patients 24/7.
Using our Accountable Care Organization’s advice, we are advancing here in rural Georgia and giving better care to our Medicare and non Medicare patients.
I believe that this Affordable Care Act has made patient record keeping complicated and, as a result, many physicians won’t even touch it due to a fear of “going down with our President” or something else.
The benefits are too great to be ignored. M Force is here to help you.
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M force will get you in a win-win-win situation, where patients win, your practice wins and medicare wins, all by saving money and improving the quality of healthcare for our seniors.
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Next week we show you how we do AWV in our practice . Please join us
May the Force be with you!