Medicare Annual There is no co pay for this preventative service - - PowerPoint PPT Presentation

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Medicare Annual Wellness Visits

February 25, 2016

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Overview

• Annual Wellness Visits are covered for all Medicare

beneficiaries on an yearly basis (prior visit + 1 day)

• There is no co‐pay for this preventative service (Z00.00)
• Good way to ensure that patients preventative services

are up to date and for the completion of ACO measures

• 91% of all FIHN members are in need of an Annual

Wellness Visit (AWV)

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Benefits

• Enhanced revenue for practice (direct revenue; more

shared savings)

• Help to maintain attribution of patients
• Better scoring on ACO / PQRS measures
• Improved member health

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Future Benefits

• May want to add Advance Care Planning (ACP) code

(99497, 99498; modifier 33)

• Good starting point for Chronic Care Management

(CCM) initial discussion and subsequent codes (99490)

• Consider adding diagnoses to maintain HCC scores

(Hierarchical Conditions Categories)

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Financial Benefit ‐ 2016

Annual Wellness Visit Initial visit G0438 $176.61 (2.43) Subsequent G0439 $119.93 (1.50) Office Visit (established) 99213 $ 75.15 (0.97) 99214 $110.66 (1.50) 99215 $149.03 (2.11) Advance Care Planning 1st 30 min 99497 $87.66 add 30 min 99498 $76.24

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How To Start

• Take Medicare patients as they come up in the schedule

‐or‐ Report separately (no charge as a preventative exam)

• Recommend 30‐40 minutes for the exam
• Consider no more than 1‐2 per day
• Pairing with regular health visit (and use 25 modifier)
• Will take ~ 1year to capture all your Medicare lives

(1 pt/day x 5 days/wk x 52 wks/yr = 260 pt/yr)

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Work flow

• Could get midlevels to do
• MD has to sign off nonproviders doing the exam
• Get nursing staff to handle as much as they can
• Use EMR to document as much as possible
• (FIHN may report % attributed pts with AWV exam)

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Annual Wellness Visit

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Acquire Beneficiary Information

• Administer Health Risk Appraisal (HRA)
• Must include:

Demographics Self‐assessment of health status Psychosocial risks Behavioral Risks ADL’s (Activities of Daily Living) Instrumental ADL’s

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Checklist for MCW Annual Visit

• Use “A Checklist for Your Medicare Wellness Annual

Visit” (handout; will be available on website)

• Have patient (or family member, if patient unable)

complete ‐ may be done ahead of time

• Scan into record

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Other Elements

• Establish/update a list of current (medical) providers

and suppliers

• Establish/update the beneficiary’s medical/family history

(may use a combination of paper questionnaires and EMR templates)

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Other Elements

• Review the beneficiary’s potential risk factors for

Depression (including current or past experiences with depression or other mood disorders)

• Review the beneficiary’s functional ability and level of

safety: Fall risk Hearing impairment Home safety

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Begin Assessment

• Measure: Height, Weight, BMI, and BP
• Consider other measurements as deemed appropriate

based on medical and family history

• Assess cognitive function (direct observation and input

from family / friends / caretakers)

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Cognitive Assessment

• Assess via direct observation (integrating concerns of

family, friends, and caretakers) – required

• May do screening for cognitive impairment (Mini‐COG;

AD8 Dementia Screening Interview)

• If positive recommend having the patient return for

another visit (or refer out for assessment)

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Depression Screening

• Suggest using PHQ‐2 as screening tool

Over the past 2 weeks, how often have you been bothered by any of the following problems: 1) Little interest or pleasure in doing things 2) Feeling down, depressed, or hopeless

• If response to either question is positive, recommend

doing a follow up PHQ‐9

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Fall Risk Assessment

• Questions on AHR (17, 18):

Have you fallen 2 or more times in the past year? Are you afraid of falling?

• Timed Up And Go (TUG) Test

Time in seconds for a patient to rise from a seated position in an arm chair, walk 10 feet, turn around, walk back to their chair, and sit back down (dependent pts generally >30 seconds)

• Consider follow up visit to discuss (or refer out)

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Counsel Beneficiary

• Establish a list of risk factors and conditions for which

the primary, secondary, or tertiary interventions are recommended or underway for the beneficiary

• Furnish personalized health advice to the beneficiary and

a referral, as appropriate, to health education or preventative counseling services or programs

• Establish a written screening schedule for the beneficiary,

such as a checklist for the next 5‐10 years, as appropriate

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Counsel Beneficiary

• Use “Counseling and Referral of Other Preventive

Services” form (handout; will be available on website)

• Written 5‐10 year plan reviewing Preventative Services
• Given patient a copy of form to take home with them

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Help With Measures (GPRO)

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Help With Measures (GPRO)

BMI (65yo and older)

• If BMI < 23

write a plan to increase weight

• If BMI 23‐30

no plan needed; weight satisfactory

• If BMI > 30

write a plan to decrease weight (for under 65yo BMI’s should be >18.5 and < 25; document if patient refuses plan)

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Help With Measures (GPRO)

Blood Pressure

• Pre‐HTN

120‐139/80‐89 record plan; f/u 1 year (plan must include lifestyle change: DASH diet; increase activity; decrease weight, sodium, or alcohol)

• HTN

>140/90 create plan; return < 4 wks (if BP remains >140/90 on follow‐up visit, then must initiate EKG, labs, or begin medication)

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Help With Measures (GPRO)

Tobacco Use

• Offer counseling
• Refer to an established smoking cessation program – FMH

Outpatient Cessation Program (240‐566‐3622)

• With proper documentation can bill in office 99406

(Smoking and tobacco use cessation counseling visit; 3‐10 minutes) or 99407 (>10 minutes); use modifier 25

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Help With Measures (GPRO)

Other Measures

• Mammogram
• Colonoscopy
• Vaccines
• Depression / Fall Risk

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Subsequent Exams

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Subsequent Exams

• Note date of visit in “comments” field in EMR, such as

“smc 2/25/16”

• Timing must be a year (and a day) from previous exam
• Watch schedule for when a Medicare patient comes up
• For q3‐6 mth visits, time as soon as last AWV as possible
• Run reports to capture patients who do not have a

follow‐up appointment (?FIHN)

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Advance Care Planning

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Advance Care Planning

• 99497 (1st 30 minutes)
• use modifier 33 with preventative service (AWV –

no copay or deductible)

• Includes:

Advance Directive MOLST Living Will Durable POA for Health Care Health Care Proxy

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Questions

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