1. Medicare Annual Wellness Visits
February 25, 2016

2. 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)

3. 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

4. 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)

5. Financial Benefit
Annual Wellness Visit Initial visit G0438 $ (2.43) Subsequent G0439 $ (1.50) Office Visit (established) $ (0.97) $ (1.50) $ (2.11) Advance Care Planning 1st 30 min $87.66 add 30 min $76.24

6. How To Start Take Medicare patients as they come up in the schedule
-or- Report separately (no charge as a preventative exam)
Recommend 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)

7. 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)

8. Annual Wellness Visit

9. 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

10. 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

11. 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)

12. 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

13. 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)

14. 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)

15. 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

16. 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)

17. 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

18. 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

19. Help With Measures (GPRO)

20. Help With Measures (GPRO)
BMI (65yo and older)
If BMI < 23 write a plan to increase weight
If BMI 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)

21. Help With Measures (GPRO)
Blood Pressure
Pre-HTN / 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)

22. Help With Measures (GPRO)
Tobacco Use
Offer counseling
Refer to an established smoking cessation program – FMH Outpatient Cessation Program ( )
With proper documentation can bill in office (Smoking and tobacco use cessation counseling visit; minutes) or (>10 minutes); use modifier 25

23. Help With Measures (GPRO)
Other Measures
Mammogram
Colonoscopy
Vaccines
Depression / Fall Risk

24. Subsequent Exams

25. 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)

26. Advance Care Planning

27. 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

28. Questions