1. Medicare Annual Wellness Exam Presented by: Susan Duden, CPC. March 24, 2012

2. Medicare Preventative Services  Welcome to Medicare exam and physical  Vaccines  Various Screening procedures  Annual Wellness exam

3. Welcome to Medicare physical  Must be performed within 12 months of the patient’s effective date of Medicare part B  Once in a lifetime procedure  Screening EKG is only allowed if referral from the IPPE appointment  G0402

4. Vaccines  Flu Vaccine, one per flu season  Pneumococcal, 1 per lifetime, unless at risk patient  HBV, limited to high risk patients

5. Various screening Procedures  Prostate blood screening, 1 per year  Mammography, 1 per year  GYN, every 24 months unless at high risk  Colonoscopy, 1 per ten years  Bone Mass Measurements, 1 per 24 months  Etc.

6. Annual Wellness Exam  Allowed 1 per year  Cannot be done within a year of the Welcome to Medicare Physical  12 months apart  G0438, first visit for wellness exam  G0439, subsequent visits, every 12 months

7. Who can perform this exam?  Doctor of Medicine or Doctor of Osteopathy  Nurse practitioner  Physician Assistant  Clinical Nurse Specialist  Health Professional Health educator, registered dietitian, nutrition professional or a team of medical professionals working under the direct supervision of a Physician

8. What is included in the Annual Wellness Exam?  This is not a hands on physical!  Patient History  Benign examination  Counseling

9. Establishing the Medical/Family History  Collect and document the following: Past medical and surgical history Allergies Use or exposure to medications and supplements Family history for disease or illness that may be hereditary or place beneficiary at increased risk. A list of providers and suppliers the patient is currently using

10. Review of patient’s Risk Factors  Screening for depression  Screen for risk of falls  Questions on home safety  Questions on hearing impairments  Cognitive abilities  The abilities to perform activities for daily living

11. Benign Examination  Height  Weight  Body Mass Index (BMI)  Blood pressure

12. Establishing a Written Screening Schedule  Make a check list for the next ten years  Based on the patient health status and history  Include age appropriate preventative services Up to and including bone mass measurements, prostate cancer screening, colonoscopy, mammography, seasonal flu vaccine and pneumococcal vaccine, and, if the patient meets the Medicare guidelines, a hepatitis B vaccine.

13. Establish a List of Risk Factors  Risk factors or conditions where intervention might be necessary  A list of treatment options and their associated risks and benefits

14. Furnishing advise to patient on preventative counseling  Personalized health advice with referrals as appropriate Including weight loss, physical activity, smoking cessation, fall prevention nutrition and alcohol abuse

15. Subsequent Annual Wellness Exams  Frequency is 1 per year  Updating any of the provider or supplier information, family history, etc  Assessing cognitive impairment  Weight, BMI, Blood pressure

16. Continued Counseling  Update the written screening schedule developed at the initial wellness exam  Update any risk factors that may have been identified  Personalized referrals as appropriate. Including lifestyle interventions, weight loss, physical activity, smoking or alcohol cessation, fall prevention and nutrition.

17. Frequently asked questions  Is the AWV the same as a yearly physical?  Are clinical laboratory tests part of the AWE?  Is there a deductible or coinsurance due for the AWE?  Can a separate E&M be done on the same day?

18. What the Patient should bring to the Annual Wellness Exam  A full list of current providers and suppliers involved in providing care  Family Health history with as much detail as possible  Medical records, including immunization records  A full list of medications Including supplements such as calcium and vitamins How often and how much are they taking

19. Questions?

20. CMS links for Preventative Information  http://www.cms.gov/PrevntionGenInfo/ http://www.cms.gov/PrevntionGenInfo/  https://www.cms.gov/MLNProducts/downloa ds/MPS_QRI_IPPE001a.pdf https://www.cms.gov/MLNProducts/downloa ds/MPS_QRI_IPPE001a.pdf  https://www.cms.gov/MLNProducts/35_Preve ntiveServices.asp https://www.cms.gov/MLNProducts/35_Preve ntiveServices.asp  https://www.cms.gov/MLNProducts/downloa ds/AWV_Chart_ICN905706.pdf https://www.cms.gov/MLNProducts/downloa ds/AWV_Chart_ICN905706.pdf