Easily Identify Eligible Medicare Beneficiaries For Annual Wellness Visits

What exactly is an Annual Wellness Visit? 

There is often confusion with the term “annual wellness visit” and its similarities to an annual physical exam. An annual wellness visit is known as an AWV. On the other hand, an annual physical exam can be referred to as several colloquial names such as physical examination, wellness exam, yearly physical, yearly checkup, or routine physical. In addition, both services include the collection of vitals such as blood pressure and body mass index (bmi). Similarities aside, there is a clear distinction between the two types of visit. 

An Annual Wellness Visit is different from the commonly known annual physical exam in several ways. Yearly physicals include an examination by the primary care provider (including doctors, nurse practitioners, or physicians assistants) of the patient’s body and current health. They also can be completed for any patient, regardless of age. In contrast, AWVs can be performed by a wider variety of medical professionals, extending to clinical nurse specialists and nurse practitioners.

Unlike an annual physical, the AWV does not require a physical exam, but rather is a preventive service that assesses aspects of a Medicare patient’s self-reported health status, family history and medical history to identify risk factors. This is done through a health risk assessment (HRA), which is a questionnaire that the patient can complete on their own. 

Once the questionnaire is complete, a personalized prevention plan is generated that alerts the provider of risk factors, preventive services to move forward with, and offers opportunities for tertiary follow up services and treatment options. Unlike annual physicals, AWVs can only be completed for eligible Medicare beneficiaries. 

Since an AWV is classified as a “preventative” service by CMS, patients have no copay or financial obligation.  

Who are “Eligible Medicare Beneficiaries?”

Within their first year of Medicare part B coverage, all Medicare beneficiaries are eligible for the IPPE, or “Welcome to Medicare” visit. After that, each beneficiary is eligible once per year for a Medicare annual wellness visit that requires no coinsurance (copayment). Where eligibility becomes complex is this: the AWV can only be performed by one healthcare provider, even though primary care physicians, urgent care providers and certain specialty providers are allowed to complete AWVs. In addition, an AWV can only be performed every 12 months. That means if you are one day off or do not know that a separate health care provider has already performed an AWV, you are duplicating the effort and will not be reimbursed by Medicare. 

How can you ensure eligibility? 

So how can practices easily identify eligible beneficiaries without risking errors? It’s all about the technology. If your team has ever completed an entire Annual Wellness Visit and billed for it just to find out that the patient was ineligible, you can understand why it is crucial to have real-time eligibility data. ChartSpan’s RapidAWV™software syncs with the HETS database to pull real-time eligibility data. This allows practices to ensure they have the most up-to-date eligibility checks as possible. Walk-in office visits are no problem since front desk staff can simply run an eligibility check right then and there.  
Using technology with real-time eligibility data will not only guarantee the accuracy of your data, but it oftentimes uncovers patients that you may not have found during a manual lookup. ChartSpan has seen this “perk” with several of our customers who are operating at over 100% of their expected annual wellness visit completion rate. If a practice truly wants to maximize their AWV performance, real-time eligibility technology is vital to the program. To learn more about how ChartSpan’s real-time eligibility feature works, visit chartspan.com/awvdemo/.

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