1. Medicare Wellness Visits for FQHCs

2. Medicare Wellness Visit

3. Who is eligible for an IPPE or AWV?
Medicare covers an AWV for all beneficiaries who are no longer within 12 months after the eligibility date for their first Medicare Part B benefit period, and who have not had either an IPPE or an AWV within the past 12 months.
Medicare pays for only one first AWV per beneficiary per lifetime and one subsequent AWV per year thereafter.

4. Initial Preventative Physical Exam (IPPE): What’s Required?
Health Risk Assessment
Family, Medical, and Surgical History
List of Current Providers
Vitals (Including BMI)
Cognitive Assessment
Depression Screening
Advance Care Planning Services (At the discretion of the Beneficiary)
Functional Ability
Falls Risk
ADLs
Hearing Impairment
Home Safety
Screening Schedule for the Next years (Recommendations from the USPTF and ACIP)
List of Risk Factors
Health Advice, Referrals, Health Education, Preventative Counseling

5. Annual Wellness Visit (AWV) What’s Required?
Review and Update Health Risk Assessment
Update Family, Medical, and Surgical History
Update List of Current Providers
Vitals (Including BMI)
Cognitive Assessment
Depression Screening
Advance Care Planning Services (At the discretion of the Beneficiary)
Functional Ability
Falls Risk
ADLs
Update the Screening Schedule for the Next 5-10 years (Recommendations from the USPTF and ACIP)
Update the list of Risk Factors
Health Advice, Referrals, Health Education, Preventative Counseling

6. Coding for the IPPE and AWV
Note: Refer to your billing and coding staff at your health centers for appropriate billing processes. Coding practices may differ based on coding and billing workflows. This information is to provide guidance on codes accepted by CMS only.
For more information on FQHC billing, please refer to:

7. Billing for the IPPE and AWV

8. Coding the Advance Care Planning
ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a beneficiary to discuss the beneficiary’s wishes and preferences for medical treatment if they are unable to speak or make decisions in the future.
You can provide the ACP at the time of the AWV, at the beneficiary’s discretion.
Not subject to a deductible and co-pay ONLY when performed during an Annual Wellness Visit or Initial Preventative Physical Exam
A diagnosis code must be included when billing

9. AFTER Patient arrives at PHS BEFORE Patient arrives at PHS
SITE: MA (Assessment)
Start AWV document
Red carpet patient
Falls assessment
Perform TUG Assessment (If needed)
Bring to Room
Check and record vitals
Depression Screen
> 65yo use Geriatric Screen
< 65yo use PHQ9
View All Protocols
Notify Pharm via IM that pt is ready
SITE: CARE TEAM
Re-scrub schedule for flips
Pre-Visit Planning Huddle
SITE: PHARMACY
Begin medication reconciliation
Document allergies
Enter medication refills
Click “Verify Medications” Button
SITE: CM/MA/RN
Acquire Information (CM)
ADL/IADL/Risk Factors
Establish list of current providers
PMH/FH/SH
Advance Directives
Mini Cog
PACE eligibility
Counsel (RN)
Care plan education
Document assessments
CPOE
Order vaccines
If needed (MA)
Administer vaccines
Give iFOBT
SITE: PROVIDER
Review assessments
Confirm f/up plan
Perform BRIEF face-to-face
Provider signs off
Print Clinic Visit Summary (CVS)
Give to pt and walk to next area OR
IM MA and MA can give CVS to pt and walk to next area
IF NEEDED
LAB: Bloodwork if appropriate (5 days)
PHARMACY: Pick up meds
Visit Complete
PHS Annual Wellness Visit Checklist

10. BEFORE Patient arrives at PHS AFTER Patient arrives at PHS
PHS Annual Wellness Visit Work Flow
Before AWV
Day of AWV
Day of AWV
BEFORE Patient arrives at PHS
SITE: PROVIDER
Review assessments
Confirm f/up plan
Perform BRIEF face-to-face
Provider signs off
Print Clinic Visit Summary (CVS)
Give CVS to patient and walk to next area OR
IM MA and MA can give CVS to pt and walk to next area
CORP: POP MGMT
Identify patients
Distribute reports
SITE: CARE TEAM
Re-scrub schedule for flips
Pre-Visit Planning Huddle
AFTER Patient arrives at PHS
SITE: POP MGMT
Pop Mgmt. Calls
Admin pop-ups
Clinical pop-ups
Both w/ end dates
All team members schedule:
As Add-On or RN Slot
Use TTT in provider slot 40 mins later
PCC confirms calls
Reminds patient to bring pill/med bottles
SITE: MA (Assessment)
Start AWV document
Red carpet patient
Falls assessment
TUG Assessment if needed
Bring to room
Check and record vitals
Depression Screen
> 65yo use Geriatric Screen
< 65yo use PHQ9
View All Protocols
Notify Pharm via IM
IF NEEDED
Patient to Lab:
Bloodwork if appropriate
Remind pt that it takes 5 days for lab results to come back
Patient to Pharmacy
Pick up medications
SITE: PHARMACY
Begin medication reconciliation
Document allergies
Enter medication refills
Click “Verify Medications” Button
PRE-VISIT PLANNING
Care Management (CM)
Review weekly schedule Friday before AWV
Look for flips
Make schedule
CM distribute schedule to:
Health care Team RN
Pharmacy
RN PVP
Screenings
Vaccines
Prior AWV
Pharmacy PVP
Assess co-pay;
Visit
Shingles Vaccine
Prints med list
Checks med refills/90 day supply/allergies
Visit Complete
SITE: CM/MA/RN
Acquire Information (CM)
ADL/IADL/Risk Factors
Establish list of current providers (Specialists/DME)
PMH/FH/SH
Advance Directives
Mini Cog
PACE Eligibility
Counsel (RN)
Care plan education
Document assessments
CPOE
Order Vaccines
If needed (MA)
Administer vaccines
Give iFOBT
Notes:

11. Where can I find more information about the IPPE and AWV?
Medicare Learning Network-IPPE and AWV Information

12. Medicare AWV: 30-minute webinar
 Optimizing Utilization and Implementation of Medicare’s Annual Wellness Visits (AWV) (control click to follow link)

13. Medicare AWV Questions
What are the benefits of providing the wellness visits?
What is the difference in the visits?
Who can perform the wellness visits?
If the visit is done at a FQHC does a provider (MD, DO, PA, NP, and CNM) have to see the patient?
If the AWV provider is a NP or PA will the visit count toward ACO assignment?

14. 1. IPPE & Annual Wellness Visits Benefits
No cost to patient!!
Generates revenue for the health center
Supports ACO attribution
Opportunity to address gaps in care
Opportunity to meet GPRO measures (ex., falls assessment)
Could help improve accuracy of HCC coding
Potential additional benefits:
Keep patients healthy
Enhances quality of care
Improves patient engagement
Promote preventive health
Help to build retention

15. 2. The Initial Preventative Physical Exam IPPE (“Welcome to Medicare” Preventive Visit)
The patient must receive this service within the first 12 months after the effective date of their Medicare Part B coverage. One-time benefit. Consists of the following:
Review the patient’s medical and social history;
Review potential risk factors for depression and other mood disorders;
Review functional ability and level of safety;
Measurement of height, weight, body mass index (BMI), and visual acuity screening.
End-of-life planning (upon agreement of the individual);
Education, counseling and referral based on the review of previous 5 components; and
Education, counseling and referral for other preventive services, including a brief written plan such as a checklist.
Who can perform an Initial Preventive Physical Exam?
Medicare Part B covers an Initial Preventive Physical Exam if it is furnished by a:
Physician (doctor of medicine or osteopathic medicine), or
Other qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical nurse specialist) 2.
MLN Matters® Number: SE1338 Re-issued

16. 2. 1st AWV and Subsequent AWVs
The first AWV includes the following elements:
A health risk assessment;
Establishment of a current list of provider and suppliers;
Review of medical and family history;
Measurement of height, weight, BMI, and blood pressure;
Review of potential risk factors for depression and other mood disorders;
Review of functional ability and level of safety;
Detection of any cognitive impairment the patient may have;
Establishment of a written screening schedule (such as a checklist);
Establishment of a list of risk factors; and
Provision of personalized health advice and referral to appropriate health education or other preventive services.
Subsequent AWVs include the following elements:
Review of updated health risk assessment;
Update of list of current providers and suppliers;
Update medical and family history;
Measurement of weight and blood pressure;
Detection of cognitive impairment the patient may have;
Update of the written screening schedule (such as a checklist);
Update of the list of risk factors; and
Provision of personalized health advice and referral to appropriate health education or other preventive services. 2.
MLN Matters® Number: SE1338 Re-issued

17. 3. Who Can Perform the AWV? Who can perform the Annual Wellness Visit?
Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by the following:
Physician (doctor of medicine or osteopathy)
Physician assistant
Nurse practitioner
Clinical nurse specialist
Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy).
CMS is not assigning particular tasks or restrictions for specific members of the team. We believe it is better for the supervising physician to assign specific tasks to qualified team members (as long as they are licensed in the State and working within their state’s scope of practice). This approach gives the physician and the team the flexibility needed to address the beneficiary’s particular needs on a particular day. It also empowers the physician to determine whether specific medical professionals who will be working on his or her wellness team are needed on a particular day. The physician is able to determine the coordination of various team members during the AWV.
Definitions: Levels of Supervision General Supervision - means the procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. Under general supervision, the training of the nonphysician personnel who actually perform the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician. Direct Supervision - in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean the physician must be present in the room when the procedure is performed. Personal Supervision - means a physician must be in attendance in the room during the performance of the procedure.
Medicare area claims processor
3. Frequently Asked Questions from the March 28, 2012 Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit

18. 4. Does a Provider have to see the patient?
At a FQHC, Yes
Billable Visit- Face-to-face encounter between the patient and a Physician, Physician Assistant (PA), Nurse Practitioner (NP), Certified Nurse Midwife (CNM), Visiting Nurse, Clinical Psychologist (CP) or Clinical Social Worker (CSW) during which a FQHC service is rendered.
4. Specific Payment Codes for the Federally Qualified Health Center December 2016
Prospective Payment System (FQHC PPS)
(Rev )
Sent: Tuesday, July 18, :29 AM To: CMS FQHC-PPS Subject: Medicare Annual Wellness Visit
If a RN performs the annual wellness visit, is it necessary for the practitioner to see the patient to bill for the service (G0438 or G0439)?

19. 5. Can NPs & PAs perform the AWV for FQHC patients?
Yes
ACO professional means an individual who is Medicare-enrolled and bills for items and services furnished to Medicare fee-for-service beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant in accordance with applicable Medicare regulations and who is either of the following:
(1) A physician legally authorized to practice medicine and surgery by the State in which he or she performs such function or action.
(2) A practitioner who is one of the following:
(i) A physician assistant (as defined at § (a)(2) of this chapter).
(ii) A nurse practitioner (as defined at § (b) of this chapter).
(iii) A clinical nurse specialist (as defined at § (b) of this chapter).
This is where we have to switch hats between a FQHC and the ACO. In the MSSP regulation ACO professional is defined as …
5. Title 42 - Public Health Chapter IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
Subchapter B - MEDICARE PROGRAM (CONTINUED)Part MEDICARE SHARED SAVINGS PROGRAMSubpart A - General Provisions
Section § Definitions.