Annual Wellness Visits

With Health Administrators changing place of service/employment and organizations expanding their presence in Primary Care Practices (PCP), there are many areas of focus for the PCP, of which one of them is Annual Wellness Visits.

An Annual Wellness Visit (AWV) has the following characteristics:

• It is an enhanced visit that lasts 45-60 minutes, at no-cost to the patient, including preventive labs
• The goal is to see every Medicare patient every year and for this service to be billed once per calendar year
• The benefit refreshes January 1 of every year. There is no need for the PCP to wait 365 calendar days between visits
• In addition to the traditional AWV CPT codes G0438 and G0439, some insurance plans offer the ability for the PCP to submit additional codes for reimbursement.  Check your local plans for details.
• AWVs need to be performed by a primary care physician, contracted nurse practitioner, or PA

 During an Enhanced Annual Wellness Visit the practitioner must

• Document patient’s current chronic conditions and ongoing treatment plans
• Conduct preventive screenings for conditions such as high blood pressure, diabetes, depression, and heart disease
• Review medications
• Schedule preventative treatments: colonoscopy, blood work, mammogram, etc.
• Complete lab work as necessary
• Use a pre-populated template based on the requirements of the specific payer

Benefits of an Enhanced Annual Wellness Visit

• Allows for accurate reporting/submission of patient’s chronic conditions to Medicare in the current year
• Maintains best practice of seeing your patients at least once a year
• Allows opportunity to identify care gaps and create a plan of care for the year
• Ensures acceptable medical record documentation in the case of a Risk Adjustment Data Validation (RADV) audit.
• Compliance with Star Measures is also required by CMS.
• Other considerations:  

CMS measures outcomes in multiple domains, including measures focused on your efforts to manage chronic conditions/issues in the Medicare population:

                                          i.    Osteoporosis

                                        ii.    Diabetes (retinopathy, nephropathy, HgbA1c, and cholesterol control)

                                       iii.    Hypertension

                                       iv.    Rheumatoid arthritis

v.  Bladder control

This is just a quick overview of the Annual Wellness Visit. If you find yourself or your organization getting more involved in Primary Care Practice Management, this is one of several areas that you as a Healthcare Administrator can find areas of efficiency for both the practice, and most importantly, the patient.

Submitted by Kevin Harrington, MATS, MSHA, RHIA, CHP, Full-Time Faculty, SJC