Ultimate Medicare Annual Wellness Visit Checklist for Providers
Medicare Annual Wellness Visits (AWVs) can significantly reduce healthcare costs, strengthen the relationship between providers and patients, and enhance patients’ quality of care. However, the adoption of AWVs since their introduction in 2011 has been slow, due to the complexities and confusion surrounding them for providers and patients.
Nonetheless, the elderly population in developed and developing countries is expected to rise from 11% of the global population in 2011 to 22% by 2050. And naturally, chronic conditions, disabilities, and diseases within the senior population will increase as well. This growth makes AWVs vital for disease prevention and management and healthcare cost control.
Failing to follow all necessary steps of the AWV, including correctly documenting and billing for the visit, can result in claim denials and frustration. But simplifying AWV appointments, workflows, and patient education with a step-by-step checklist and flexible AWW software can help remove hurdles that discourage participation.
At ChartSpan, we aim to improve your practice’s efficiency and effectiveness at conducting AWVs and caring for your patients with chronic conditions. To assist you, we’ve created a straightforward AWV checklist and AWV software so you can conduct AWVs confidently, care for your patients thoroughly, and maximize reimbursements.
What’s covered in this article:
|What are AWVs?||The importance of AWVs||The challenges of AWVs|
|How to simplify AWVs||The ultimate AWV checklist||How ChartSpan’s software streamlines AWVs|
The Medicare Annual Wellness Visit (AWV) is a scheduled time for the provider to screen for patient health risks with a Heath Risk Assessment (HRA), create preventive care plans, update medical records, and educate patients on how to manage their health. An AWV is free to eligible Medicare patients.
Patients eligible for AWVs must meet the following criteria:
- Enrollment in Medicare Part B over 12 months
- 12 months since the initial Welcome to Medicare visit
- No AWV conducted in the last 12 months
An AWV is not a physical exam and should not be used to examine, diagnose, or treat patients. The goal of an AWV is preventing disease and improving the patient’s quality of life rather than finding and treating new health issues.
- Identification of health risks
- A review of the patient’s medical history
- A review of current medications and specialty providers
- Documentation of vitals like height, weight, and blood pressure
- Discussion and documentation of care plans and chronic disease management
- And discussion of the social determinants of health
New Medicare Part B patients are encouraged to schedule an Initial Preventive Physical Exam (IPPE), also called a “Welcome to Medicare Visit.” During this visit, patients complete an HRA and receive a preventive care plan. 12 months after their IPPE, Medicare patients are eligible for their first Annual Wellness Visit and are subsequently eligible for another AWV every 12 months.
The evidence of AWVs in reducing healthcare costs, increasing provider reimbursements, and improving care is exciting, but studies are limited due to the slow increase in participation from providers and patients. Many providers and patients do not grasp the benefits of AWVs for the patient’s well-being.
However, a recent study by the American Journal of Managed Care (AJMC) reveals that AWVs had the following benefits among 8,917 Medicare beneficiaries at 44 primary care clinics participating in two Accountable Care Organizations (ACOs).
- Medicare reimbursements of $175 per member per year
- Reduction in healthcare costs for patients with an AWV
- Greater performance in quality measures for screenings
- Reduction in hospital acute care costs
- Reduction in hospital outpatient non-ED costs
For senior patients, AWVs identify potential health risks early and create personalized care plans tailored to their needs. AWVs allow for early detection of health issues through comprehensive assessments, giving patients the opportunity for timely intervention and improved treatment outcomes. These visits empower patients to make informed decisions about their health and discuss their concerns. Additionally, AWVs are covered by Medicare at no cost to an eligible patient.
Despite these provider and patient benefits, the AJMC study emphasizes that barriers to AWVs include a lack of time and resources, challenges managing the workflow, and complex Medicare requirements. For this reason, AWV software is crucial to successful AWVs. RapidAWV from ChartSpan integrates with your EHR, reports on patient progress, identifies patient risk factors with a comprehensive HRA, and creates provider and patient reports.
The complexities AWVs create for practice workflows cannot be overlooked, but they are possible to overcome with the right tools and assistance to streamline documentation, automate tasks, and facilitate efficient coordination.
1. Complex requirements for providers
As part of the AWV workflow, Medicare requires that practices accurately document the visit, follow coding guidelines, ensure patient eligibility, and understand which services are or are not covered. Non-compliance with these requirements leads to claim denials, payment recoupment, or legal consequences.
Adhering to Medicare’s AWV guidelines quickly becomes overwhelming as providers struggle to find the time, staff, and energy to ensure reimbursement. Automating processes and streamlining your workflow with AWV software is essential if your practice faces limitations in conducting successful AWVs.
2. Lack of patient awareness and education
Many patients perceive AWVs as not worth their time or confuse them with yearly physical exams and leave frustrated that the appointment did not meet their expectations. Some patients want new health concerns diagnosed or prescriptions refilled during an AWV.
Patient confusion also discourages providers from conducting AWVs because providers are worried about disappointing patients, performing services that Medicare doesn’t cover, or not meeting AWV requirements. Patients need education on the value and intent of the AWV so they aren’t confused and have a positive experience.
3. Lack of clarity for physicians
AWVs can be just as confusing for physicians as they are for patients. In the exam room, physicians report difficulty discerning which services they should or should not provide and preventing the visit from crossing the boundaries. They may struggle to meet all the required AWV services if the appointment ventures off-course.
In such scenarios, patients are usually lacking education about the visit, and the practices usually do not have a clear workflow or process for the AWV appointment.
1. With a provider AWV checklist
A provider checklist can serve as a systematic guide for healthcare providers. It ensures that all necessary components of an AWV are addressed and reduces the chances of missing any crucial steps or documentation requirements.
2. With team effort
A physician is not the only practitioner qualified to conduct an AWV. AWVs may also be performed by a nurse practitioner, registered nurse, physician assistant, or other licensed health professional under physician supervision. Sharing the responsibility of conducting AWVs among the practice staff improves the visits’ efficiency without compromising the quality of care.
Learn more: Who Can Perform AWVs?
3. With automated eligible patient identification
By automating or offloading patient eligibility verification, providers can focus on delivering care. ChartSpan’s AWV software automatically tackles the first step in ensuring AWV reimbursement by running patients’ names against the Medicare HETS database in real time to ensure eligibility.
Learn more: How to Identify Eligible Patients for AWVs
4. With a robust Annual Wellness Visit software
Conducting AWVs without software is impractical for most providers. AWVs typically cover a comprehensive agenda, including a Health Risk Assessment (HRA), risk factor identification, and personalized care planning. Manually sifting through patient data from the HRA and creating a report can be time-consuming.
ChartSpan’s AWV software includes a tablet-friendly HRA completed in the waiting room. The software then analyzes and documents patient data and creates a detailed report that automatically flags and prioritizes risk factors and enables providers to create a thorough care plan. Patients also benefit from a straightforward report that outlines their risks and includes their care plan.
5. With Telehealth AWVs
Telehealth AWVs benefit patients with mobility or transportation challenges. Our telehealth-friendly AWV software allows providers to remotely assess patients, discuss their health concerns, and develop care plans. Telehealth AWVs save time for both providers and patients, improve access to care, and enable a more convenient AWV experience.
It’s important to note that service and documentation requirements do not change for telehealth AWVs and that the IPPE must be in-person.
6. With a thorough Chronic Care Management (CCM) program
A CCM program provides regular communication, care coordination, and monitoring of chronically ill patients outside of AWVs. By proactively managing chronic conditions, providers can address health concerns more effectively during AWVs and ensure better overall health outcomes for patients.
Using an AWV checklist helps you stay on task during the visit for accurate documentation and reporting while ensuring a consistent and comprehensive AWV experience for your patients.
1. Ensure accurate patient eligibility
Verify that the patient meets the eligibility criteria for an AWV, such as being enrolled in Medicare Part B, having had their IPPE visit, or having received their previous AWV no sooner than 12 months prior.
Verifying eligibility for each patient can quickly become tedious. ChartSpan’s RapidAWV offers automatic eligibility checks against the Medicare (CMS) HETS database, so you can complete the first step of the AWV before the patient even enters the room, saving you time and eliminating the hassle of manual verification.
2. Conduct a Health Risk Assessment (HRA)
Administer a comprehensive HRA questionnaire to assess the patient’s health risks, including current health conditions, medical history, cognitive impairment, and activities of daily living (ADLs), among other health issues.
Step two can also be completed before the visit begins with our AWV software, which includes a thorough, 10–12 minute HRA completed by the patient on a tablet in the waiting room. RapidAWV™ efficiently identifies, collects, and flags patient risk factors. The provider receives a detailed HRA report so you can develop a personalized, proactive care plan for the patient.
3. Communicate the goals and expectations of the visit
To avoid confusion and improve patient satisfaction, clearly explain the purpose of the AWV to the patient, highlighting the focus on preventive care, the purpose of the health assessment, and the goals of personalized care planning.
4. Take the patient’s measurements
Record your patient’s vital signs, including blood pressure, height, weight, and body mass index (BMI), to establish baseline measurements and assess their overall health. These routine measurements can be easily recorded before or after completing the HRA using our user-friendly software.
5. Document medical and family history
Gather detailed information about the patient’s medical history, including past illnesses, surgeries, and chronic conditions. Also, document relevant family history that may indicate genetic risks.
6. Create a record of current providers and suppliers
Collect information about the patient’s current healthcare providers and suppliers for effective coordination of care across the healthcare team.
7. Identify risk factors
Identify and document the patient’s risk factors for various health conditions, such as smoking, a sedentary lifestyle, dietary habits, and environmental exposures, using the results of the HRA.
8. Assess cognitive abilities
Observe or use a screening test to evaluate the risk of dementia or Alzheimer’s. ChartSpan’s HRA includes screening questions to help you detect signs of cognitive impairment.
9. Assess for depression and other behavioral disorders
Screen the patient for symptoms of depression and other behavioral disorders using the HRA and provide appropriate care and referrals if needed.
10. Assess the patient’s safety and functional ability
Evaluate the patient’s ability to perform daily activities and assess their safety at home, identifying fall risk, hearing impairment, or other limitations that may require support or interventions.
11. Review opioid prescriptions
Review the patient’s current opioid prescriptions to ensure appropriate usage and identify any potential misuse or dependence, and collaborate with the patient’s other providers if adjustments are necessary.
12. Identify potential substance abuse disorders
Screen for substance abuse disorders, and if risks are identified, provide appropriate interventions, referrals, or counseling resources.
13. Identify ancillary services
Identify additional preventive services or referrals the patient may benefit from, such as nutrition counseling, physical therapy, social services, or other supportive programs.
14. Send referrals if necessary
Based on the findings during the AWV, make referrals to specialists or other healthcare professionals for further evaluation or management of specific conditions or concerns. However, it’s important to inform the patient if Medicare does not cover the specialist service required.
15. Create a written screening schedule
Develop a personalized screening schedule for the patient, outlining recommended screenings, vaccinations, and preventive services based on age, gender, and individual risk factors. ChartSpan’s AWV automatically generates a five- to ten-year screening schedule based on the risks revealed in the HRA.
16. Create a personalized patient care plan
Develop a comprehensive care plan tailored to the patient’s needs, incorporating preventive measures, lifestyle modifications, medication management, and any necessary follow-up appointments or services.
You’re also required to provide the patient with a copy of this care plan. RapidAWV™ creates a patient summary of their care plan to help them continue preventive care outside of your practice.
17. Optional step: Identify high-risk patients for Advanced Care Planning (ACP)
Patients nearing end-of-life may benefit from discussing their wishes for future medical care, particularly in the event of serious illness. ACPs involve conversations about the patient’s values, goals, and desired outcomes, as well as decisions regarding medical treatments, resuscitation, life-sustaining interventions, and palliative or hospice care. ACP is optional and up to the patient’s discretion.
18. Code and bill carefully
Accurate coding and documentation following Medicare guidelines are crucial to receiving reimbursement and avoiding compliance issues or claim denials. It’s important to stay up-to-date with Medicare’s coding and billing guidelines and documentation requirements.
Billing codes for AWVs include G0402 for IPPEs, G0438 for the first AWV, and G0439 for subsequent AWVs. RapidAWV™ comes with a RapidBill™ feature that makes it easier to bill the correct AWV code.
Learn more: What Are the CPT Codes for AWVs?
Note: This AWV checklist can serve as a tool to help you have effective and efficient AWVs. However, it does not outline Medicare’s specific requirements in detail. For specific information on documentation, coding, and billing, please refer to the most recent Medicare guidelines.
ChartSpan’s RapidAWV™ software can improve the quality of care delivered during AWVs and maximize the value of each visit. Our software is designed to help you overcome the complexities of AWVs with automatic eligibility checks, tablet-friendly HRAs, and comprehensive provider and patient reports.
By seamlessly integrating with your practice’s EHR, RapidAWV™ ensures that vital patient information is readily accessible, enabling you to provide personalized care plans tailored to each patient’s unique needs.
The detail provided through our AWV software enhances the value of every visit with tools to elevate the quality of care you provide, capture greater reimbursements, and strengthen your relationships with patients.
Successful AWVs for your practice
Proper planning, a well-structured workflow, a clear understanding of Medicare requirements, and robust AWV software are all essential to successful AWVs. At ChartSpan, we specialize in helping healthcare providers streamline their AWV process and get rewarded for proactive patient care. Contact us to discover how we can help you enhance the efficiency and maximize the value of each AWV visit.
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Published: June 22, 2023
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