Since the Centers for Medicare & Medicaid Services (CMS) began covering Annual Wellness Visits (AWV) in 2011, the value of this yearly assessment has continued to increase.
AWVs offer a pivotal opportunity to set a course for improving a patient’s health. This includes enrolling the patient in any appropriate care management programs.
The Annual Wellness Visit opportunity
Just as a quick reminder, an Annual Wellness Visit is provided to Medicare Part B beneficiaries. There are three types, including:
- Initial Preventive Physical Exam (IPPE): Also known as the Welcome to Medicare appointment, the IPPE is a one-time, face-to-face service offered to newly enrolled patients in Medicare Part B and is a precursor to subsequent Annual Wellness Visits. Using code G0402, this service is only provided in the initial 12-month window after a patient enrolls and will be rejected after that timeframe elapses.
- Initial Annual Wellness Visit: Using CPT code G0438, the patient may have their first Annual Wellness Visit one year after completing an IPPE or 12 months after enrollment in Medicare if they didn’t have an IPPE.
- Subsequent Annual Wellness Visits: Every AWV after the IPPE and initial AWV falls under code G0439. Patients become eligible for AWVs once every 12 months.
According to CMS, the AWV can be furnished by the following clinicians:
- Physician
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Medical professional such as a health educator, registered dietitian, nutrition professional, or other licensed practitioner
- A team of medical professionals working under the direct supervision of a physician
Harnessing the value of the AWV
Annual Wellness Visits have been shown to impact healthcare in many positive ways. One study found that Medicare patients experienced an average 5.7% reduction in healthcare expenses after participating in an AWV.
During the AWV, patients receive a comprehensive health risk assessment and personalized prevention plan. These cover a host of potential health and social risk issues, including:
- Establishing the patient’s risk factors and conditions
- Review age-appropriate preventive screenings needed
- Providing optional Advance Care Planning services
- Review current medications, including opioid prescriptions
- Screen for potential mental health and cognitive function issues
- Conduct an optional Social Determinants of Health (SDOH) Risk Assessment
Because the AWV is intentionally proactive, it focuses on preventive care and health maintenance while setting a direction for improving health and wellness.
Maximizing the AWV with add-ons and care management enrollment
The Annual Wellness Visit can act as a gateway toward better health outcomes by introducing specific service add-ons, as well as introducing enrollment into care management programs.
While there can be confusion around this opportunity, AWVs can be billed concurrently with problem visits, just not under the same code. Also, there are add-on services that can be billed concurrently, including:
- Advance Care Planning (CPT codes 99497 and 99498)
- Depression screening (CPT code G0444) – not permitted with the initial AWV, however.
- Smoking cessation counseling (CPT codes 99406 and 99407)
- Obesity counseling (CPT code G0447)
- Substance use disorder screening and counseling (CPT codes G0442 and G0443)
CMS also allows clinicians to enroll patients in Medicare care management programs during the AWV if they are eligible. The AWV is a great time to invite a patient into a care management program. It provides an invaluable service that supports a patient in realizing personalized health goals that align with the issues and risks discussed during the AWV.
Care management programs give the care plan structure, cadence, and substance, making it actionable. But which care management program should you offer to patients?
Which care management program is appropriate?
Figure 1 outlines the general eligibility requirements for patients to join each of the Medicare care management programs with the Annual Wellness Visit criteria listed as well. This matrix can help highlight which programs may fit your patient populations, indicating those programs you should consider offering during the AWV.
With ThoroughCare, every care management program is available without activation. You simply enroll a patient into the program, and that platform module becomes live.
Program eligibility
Figure 1: Eligibility by Medicare Program
To maximize the value of the AWV and enhance enrollment into care management programs, it helps to map out a workflow that indicates how you will engage patients before, during, and after the yearly visit.
Maximizing patient engagement before, during, and after the Annual Wellness Visit
Figure 2 shows a decision tree from The Advisory Board Company that helps visualize the workflow to prioritize enrollment as part of the AWV.
Figure 2: Decision tree for patient care management enrollment. Source: The Advisory Board Company
The workflow starts with the total patient population eligible for AWV, TCM, and CCM services. It divides that group into those currently admitted to the hospital and could be eligible for TCM services and those who qualify for an AWV.
This top-line division clarifies how many patients from your total Medicare cohort could benefit from which program.
After this initial review of sub-cohorts for CCM and TCM, you can implement a plan to engage patients before, during, and after the AWV to maximize their enrollment in the most appropriate care management program.
Patient engagement before the AWV
Communication is vital to building awareness around the purpose and value of the Annual Wellness Visit.
Any contact before the patient’s 12-month Medicare or AWV anniversary is an opportunity to highlight its value, including:
- Discuss health and social risks
- Review the patient’s healthcare priorities
- Learn about care management support programs
- Set healthcare goals
- Create a plan for the next year
Along with this communication, the care team can send the patient a Health Risk Assessment (HRA) that they can complete before the AWV or review and complete when together. The HRA is a self-guided questionnaire about the patient’s health, medical history, and lifestyle.
These items let the patient know what to expect and help them prepare for the AWV.
Patient engagement during the AWV
The American Academy of Family Physicians (AAFP) published an excellent two-part, team-based AWV workflow to optimize clinician time and give the patient role-based attention. This approach enables key care team members to engage the patient on various parts of the AWV, allowing the physician to focus on medical risk and future goal planning, including enrollment in care management.
Patient engagement after the AWV
Once the AWV is complete along with enrollment in a particular care management program, it’s critical to keep the momentum by initiating the new care management enrollment with an initial touchpoint.
For example, if a patient is enrolled in Chronic Care Management, their first non-face-to-face session would pick up from the HRA and create a patient-centered care plan.
ThoroughCare streamlines the Annual Wellness Visit and enables seamless care management enrollment
ThoroughCare offers end-to-end workflow for Annual Wellness Visits.
We simplify the process so providers can focus on engaging patients. Guided interviews help ask the right questions and ensure all service requirements are met. ThoroughCare includes digital solutions, such as:
- An interactive health risk assessment
- Screening tools, such as ADL, CAGE, DAST-10, GAD-7, MDQ, PAC, PHQ-2, and a mini cognitive exam
- A care gaps summary with recommended interventions
- A full report of Personalized Prevention Plan Services
- Comprehensive care planning tools and enrollment in care management
- Automated CPT code assignment for accurate billing
