The Must-Have Checklist for a Successful Medicare AWV Program

So, you think you’re ready to launch an Annual Wellness Visit (AWV) program. You understand the benefits and are excited to get started. But do you understand the challenges involved in running a successful Medicare AWV program? If you don’t, you and your team are headed towards wasting a lot of time, energy, and resources for a program that will reach nowhere near its full potential. To avoid the crash and burn, it’s crucial to familiarize yourself with the ten most important components of a Medicare Annual Wellness Visit program. 

1. Proper Workflow

Last year, 81% of all eligible Medicare beneficiaries did not receive an Annual Wellness Visit. If AWVs are so easy and require no coinsurance, why do so many patients fail to receive one? The majority of the problem has to do with the AWV program workflow. Historically, patients who are scheduled for only an AWV have a high no-show rate. The best way to circumvent this issue is to offer an AWV to patients as they come in for a regularly scheduled E/M visit. Turn a “sick visit” into a “well visit”. Medicare allows for an E/M visit and AWV to be completed on the same day, eliminating the need to schedule patients for a separate AWV appointment, and ultimately reducing your no-show rate. An AWV can be completed in the waiting room prior to meeting with the provider and does not require an exam room since there is no physical exam. Repurposing your waiting room for AWVs saves time and resources, and avoids patient no-shows. 

2. Accurate Patient Eligibility

If you have Medicare patients coming into your office but have no way of checking their AWV eligibility in real-time, there is a high chance you will miss patients and/or have patients complete AWVs who are not eligible. You will need to know whether or not your patients have had their IPPE or “Welcome to Medicare” visit as well as if they are eligible for a subsequent AWV. This is why it’s important to have a system that provides accurate eligibility checks against Medicare’s HETS database…in real time. You need to be able to quickly check eligibility for walk-in appointments as well as prepare for scheduled appointments so that you can maximize the amount of AWVs you perform. 

3. Health Risk Assessment (HRA)

For Annual Wellness Visits, Medicare requires the patient to complete a self-assessment questionnaire known as the Health Risk Assessment (HRA). This usually begins by collecting routine measurements such as blood pressure and body mass index (BMI). Then, the patient answers a series of questions about their family history, medications and immunizations, current health conditions and functional ability. This can include screening tests for cognitive impairment, depression, fall risk, and more. The HRA may also prompt the patient to consider talking to their current provider about Advanced Directives. Once completed, the HRA gives the provider visibility into issues that may not come up in the regularly scheduled appointment. For example, if the patient is identified at a high risk for falls, the provider can discuss strategies for fall prevention. Watch out for vended products that include complex questions or poor design attributes.  Elderly seniors struggle to complete the questionnaire in a reasonable amount of time the more complex the HRA. Large type font and accessible design are important in order to achieve success.

4. Flexibility

It is important for your AWV program to support the needs of your patients. This requires offering a program that supports multiple languages and is accessible for patients who have poor vision (large font, low reading level). Your program should also be flexible for you. As mentioned earlier, you will need a program that can accurately identify eligible patients at any time, whether you are checking the schedule the day before or running a check for a walk-in patient. Without these capabilities, you may not be able to capture all of your eligible patients. 

5. Compliance

Your Annual Wellness Visit program most importantly needs to be Medicare compliant and adhere to HIPAA. If you are outsourcing, it’s important to choose a vendor who is HITRUST Certified for security. Based on the results of the HRA, Medicare requires that you develop a risk factor analysis and review your patients’ personalized care plans to provide health advice. All documentation must be attached to the patient chart in your EMR. 

6. Documentation

Medicare requires that your Annual Wellness Visit program generates a personalized prevention plan, risk factor analysis, and five-year screening plan for each patient. Best practices show that it is helpful to offer a simple version of the care plan for the patient with a more detailed analysis for the provider. The results of the HRA can be extensive, and can take a long time to sift through manually. That is why it is recommended to invest in a software that automatically generates these reports for you. 

7. Reporting for Ancillary Services

Your program should take the results of each patents’ HRA and identify opportunities for preventive services that Medicare will reimburse for. This will help you close gaps in care as well as produce additional revenue. If you do not have insight into additional services needed, you will miss out on these opportunities.

8. Identification of High-Risk Patients

To maximize your program, you will need to identify high-risk patients based on the responses to the HRA. This will help you stay ahead of future illness and decline. Your program should analyze the relative risk factors of patients and identify patients who need to be placed into an advanced care plan.

9. Billing

The billing for your AWV program should be simple and organized, otherwise it will create headaches for your billing staff. A user-friendly interface will keep your billing team happy and efficient with their time.

10. Financial reporting

Even if you think your AWV program is running successfully, how do you really know? The answer is in the financials. You will need to closely monitor your expected versus actual revenue so that you can evaluate if you are maximizing your program’s full potential or not. Without a way to track these numbers, you are blind to the quality of your AWV program.

If you are interested in learning more about how you can implement these best practices in your AWV program, visit https://www.chartspan.com/solution/annual-wellness-visits/.

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