The Medicare Annual Wellness VisitIt’s Origin, Content, and Substance
Duke Internal Medicine
Bruce Peyser, MD FACP, Scott Joy, MD FACP,
Anne Phelps, MD, Kathleen Waite, MD FACP
May 2012
Disclosures for all four physicians
Research Support Employee No relevant conflicts of interest to declare
Consultant
Dr. Joy serves as a consultant to Lilly, other
3 physicians do not serve as a consultant
Major Stockholder
No relevant conflicts of interest to declare
Speakers Bureau
No relevant conflicts of interest to declare
Honoraria
No relevant conflicts of interest to declare
Scientific Advisory Board
No relevant conflicts of interest to declare
Disclaimer
Comments are from us as
individuals and do not represent
official recommendations from
Duke University Medical Center.
However, we are from the
Department of Medicine at Duke.
And most importantly, we are all
BLUE DEVILS and we sure love
basketball in Durham, NC.
The Medicare Annual
Wellness Visit
Many Patients Want a Medicare Annual
Wellness Visit
AWV Pitfalls-What to Watch out for??
• Insufficient or incomplete
documentation.
• Many rules and regulations,
CMS does not have all the
answers yet.
• Concurrent provision of E/M
services seems like an easy
way to get into trouble.
• These visits take time, and
your staff need to help you.
• Its not really clear what records
you must retain .
• How to do this with EPIC??
Common Questions and Course Objectives
What are the
Components of the
AWV?
What’s a HRA?
How did the AWV
get developed?
What to do when
A test is abnormal?
What are common
Errors made with
AWV’s??
How to Bill for the AWV?
How to teach learners
To do this properly?
Today’s outline-We have a really
great show!
1. AWV-Background and
Politics- Dr. Scott Joy
2. Component overview w/
focus on HRA- Dr. Kathleen
Waite
3. What to do when an
abnormality is discoveredDr. Anne Phelps
4. Billing 101-How to bill
correctly-Dr. Bruce Peyser
5. Question and Answers
6. Session Evaluation
The Magic of the AWV
Be prepared for surprises!
It’s hard to anticipate what you will
find.
This is an incredible opportunity
that we must not squander.
Sources for Our Work
Govt
websites
Audits at
Duke
Conference
call with
CMS March
2012
Experience
ACP and
AAFP web
sites
Coming to You Fall 2012-Exciting New
Websites !!
The Political History of the Affordable Care
Act and the Annual Wellness Visit
Scott V. Joy, MD, FACP
Associate Professor of Medicine
Duke Primary Care
White House
Presidential Power
• President Obama said that fixing health care would
be one of his priorities if he won the presidency
• President Obama announced to a joint session of
Congress in February 2009 that he would begin
working with Congress to construct a plan for health
care reform.
Understand The Game: How Our
Laws Are Made
United States Congress
Committees of Importance:
U. S. Senate
• Finance
– Chairman, Max Baucus, D-MT
– Ranking Member, Orin Hatch, R-UT
• HELP (Health, Education, Labor and Pensions)
– Chairman, Tom Harkin, D-IA
– Ranking Member, Michael Enzi, R-WY
• Appropriations
– Chairman, Daniel Inouye, D-HI
– Ranking Member, Thad Cochran, R-MS
Genesis of the AWV
 Beginning June 17, 2009, and extending through
September 14, 2009, three Democratic and three
Republican Senate Finance Committee Members*
met for a series of 31 meetings over 60 hours to
discuss the development of a health care reform bill
 The principles that they discussed became the
foundation of the Senate's health care reform bill.
*Senators Max Baucus (D-Montana), Chuck Grassley (R-Iowa),
Kent Conrad (D-North Dakota), Olympia Snowe (R-Maine),
Jeff Bingaman (D-New Mexico), and Mike Enzi (R-Wyoming
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
Committees of Importance:
House of Representatives
 Ways and Means
Chairman, Dave Camp, R-MI
Ranking Member, Sander Levin, D-MI
 Appropriations
Chairman, Harold Rogers, R-KY
Ranking Member Norman D. Dicks, D-WA
 Energy and Commerce
Chairman, Fred Upton, R-MI
Henry Waxman, D-CA
The Legislative History of the Affordable
Care Act
 Introduced in the House as the "Service Members
Home Ownership Tax Act of 2009" (H.R. 3590) by
Charles Rangel (D–NY) on September 17, 2009
 Committee consideration by: Ways and Means
 Passed the House on October 8, 2009 (416–0)
 Passed the Senate as the "Patient Protection and
Affordable Care Act" on December 24, 2009 (60–
39)
– “Cornhusker Kickback”
– January 19, 2010, Scott Brown elected Senator from
MA
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
Understand The Game: How Our
Laws Are Made
House agreed to Senate amendment on March 21, 2010 (219–212)
WASHINGTON, March 23, 2010 - President Obama signed the health
care bill into law today, calling its historic expansion of insurance
coverage "reforms that generations of Americans have fought for and
marched for and hungered to see.”
The Implementation Phase
 Once the ACA was passed, it became the
responsibility of CMS (under Department of Health
and Human Services, Secretary Kathleen Sebelius,
to create policies
 Each year, CMS issues regulations in the Federal
Register
 Generally the Proposed Rule comes out in the
summer for a 90 day comment period and then the
Final Rule is issued, effective January 1, 20XX
Department of Health and
Human Services
Pages 454-457
Health Risk Assessments
U.S. Alters Rule on Paying for
End-of-Life Planning
Published: January 4, 2011
 WASHINGTON — The Obama administration,
reversing course, will revise a Medicare regulation
to delete references to end-of-life planning as part of
the annual physical examinations covered under the
new health care law, administration officials said
Tuesday.
 The move is an abrupt shift, coming just days after
the new policy took effect on Jan. 1.
http://www.nytimes.com/2011/01/05/health/policy/05health.html?_r=2
Supreme Court
Supreme Court and ACA
 The Supreme Court has granted review of four issues from
challenges to the Affordable Care Act that have been pursued in
the federal courts since passage of the act in March 2010.
 The four issues on which the court has granted review are:
– Whether the Anti-Injunction Act prevents challenges to the Affordable Care
Act at this time
– The constitutionality of the individual mandate, requiring most Americans to
purchase health insurance by 2014
– Whether the individual mandate is severable if it is found to be
unconstitutional, or whether the entire Act would have to fail
– Whether the Affordable Care Act's expansion of the Medicaid program is
constitutional
http://www.hfma.org/Templates/Print.aspx?id=24263
Supreme Court and ACA
 The Affordable Care Act does not contain a
severability clause.
 Severability clauses provide that the failure of one
provision in an act of Congress does not affect the
remaining portions of the act.
 The absence of a severability clause does not mean
that provisions are not severable, but it can leave
the decision regarding severability up to the courts.
http://www.hfma.org/Templates/Print.aspx?id=24263
The Citizens Speak
Public Opinion of ACA
http://www.kff.org/kaiserpolls/upload/8302-C.pdf
Medicare’s Annual Wellness Visit:
The benefit nobody knows
Have you heard about this Annual Wellness
Visit?
In the past 12 months, have you had your
free Annual Wellness Visit?
Not sure,
9%
DK, 14%
Yes, 32%
No, 54%
Refused,
2%
Yes, 17%
No, 72%
John A. Hartford Foundation Public Poll: “How Does It Feel? The Older Adult Health
Care Experience” http://www.jhartfound.org/learning-center/hartford-poll-2012/
*Medicare’s records suggest that uptake is only 6.5 percent
35
Components of Medicare
Annual Wellness Visit (AWV)
Kathleen Waite, MD, FACP
Assistant Clinical Professor of Medicine
Division of General Internal Medicine
Duke Primary Care
Medicare Preventive Services
 Initial Preventive Physical Examination (IPPE)


One time benefit
Must be provided within the first 12 months of the patient’s
Medicare Part B coverage
 Initial Annual Wellness Visit (AWV)


Once in a lifetime benefit
If patient has received an IPPE then need to wait a full 12
months from that date of the IPPE before performing an AWV
 Subsequent Annual Wellness Visit (AWV)


Provided yearly
Must scheduled at least 11 full months from the last AWV
Goals of the AWV




Patient to review with their
health care provider overall
health status and maximize
the preventive services that
are available to Medicare
beneficiaries.
Components dictated by
Medicare.
Create a personalized
prevention plan.
It is NOT a physical exam.
Components of First AWV
 Establish Medical History



Past medical and surgical history
Allergies
Medication list INCLUDING supplements
 Establish Family History

Includes parents, siblings and children
 List of current medical providers/suppliers
 Depression screening


Review current and past experience with mood disorders.
If no history then screen with available “standard screening
test” recognized by national professional medical
organizations. (PHQ-2)
Components of First AWV
 Review patients functional ability and level of safety
 Hearing (Whisper test)
 Ability to perform ADLs (Consider Katz or other instrument)
 Fall Risk (Get up and go test)
 Home safety
 Include instrumental activities of daily living (iADLs)
 Examination
 Height, Weight, BMI or waist circumference, BP
 Other PE deemed appropriate per medical/family history
 Detection of any cognitive impairments
 Not specified – consider testing such as Mini Cog
 Health Risk Assessment (CHANGE for 2012)
This way to complete your HRA……
Health Risk Assessment (HRA)
Center for Medicare and Medicaid Services (CMS)
requires that a HRA be completed as part of the
Medicare AWV effective Jan. 1, 2012. CMS does not
require a specific HRA.
 Written at a 5th grade reading level.
 Should take no more than 20 min to complete.
 Can be complete before or during the AWV.
 Can be web based, telephonic or paper based.
CDC Guidance on HRA
 Demographic information
 Self assessment of health and physical functioning
 Biometric Assessments
 Height, weight, BP, lipids, glucose
 Psychosocial risks
 Depression, social isolation, pain, stress/anger
 Behavioral risks
 Physical activity, nutrition, sexual practices, home safety,
motor vehicle safety, tobacco use, alcohol use.
 ADLs and Instrumental activities of daily living
(iADLs)
HRA Resources

Center for Disease Control and Prevention published
online a “Framework for Patient-Centered Health
Risk Assessment”. Appendix A contains a 7 page
paper HRA. http://www.cdc.gov/policy/opth/hra

Dartmouth Co-Op Project is a non-profit organization
that has an online free HRA. Short and long online
HRA. The short HRA takes approximately 10 min to
complete. Patient is given a summary “Action and
Planning Form” which they are asked to print and
bring to the AWV.
www.medicarehealthassess.org
www.HowsYourHealth.org
http//www.medicarehealthassess.org
FAMILY PRACTICE MANAGEMENT | www.aafp.org/fpm | March/April 2012
FAMILY PRACTICE MANAGEMENT | www.aafp.org/fpm | March/April 2012
Sample HRA Printout
http//www.medicarehealthassess.org
http//www.medicarehealthassess.org
Medicine in the modern age of the AWV…..
AWV Counseling Requirement
Establishment of written screening schedule for patient
for the next 5 to 10 years.
 Based on United States Preventive Services Task
Force (USPSTF) grade A and B recommendations.
 Based on Advisory Committee on Immunization
Practices (ACIP)
 Example check list available
http://www.medicare.gov/navigation/manage-yourhealth/preventive-services/preventive-serviceoverview.aspx
https://mymedicare.gov/ (electronic form available to
patients)
http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-checklist.aspx
AWV Counseling Requirement

List risk factors and conditions which
interventions are recommended.
 Examples sedentary lifestyle, fall risk, tobacco use

Provide personalized health advice and
referrals for health education and preventive
counseling.
 http://www.cdc.gov/DiseasesConditions
 http//www.nlm.nih.gov/medlineplus
 http://nihseniorhealth.gov
USPSTF Grade A and B
Recommendations





Health Habits
Alcohol Misuse (B)
Depression Screen (B)
Obesity Screen (B)
Sexually Transmitted
Infection Counseling (B),
HIV (A) ,GC (B),
Syphilis(B)
Tobacco Use
Counseling (A)
Cardiovacular
 AAA Screening (B)
Men 65-75 with tobacco history
 ASA
Men 45-79 (A),Women 55-79 (B)
 Blood Pressure (A)
 Cholesterol Screen (A)
Men > 35, Women > 45
 Diabetes screening (B)
If BP persistently over 135/80
 Dietary Counseling (B)
If hyperlipidemia, or other CV risk
USPSTF Grade A and B
Recommendations
Cancer Screening
 Breast
 BRCA counseling high risk
family history (B)
 Chemoprevention (B)
 Mammogram (B)
Osteoporosis Screening
 Bone density
All women 65 and older.
 Cervical (A)
 Colon (A)
http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
Preventive Services Covered
by Medicare









Immunizations: Flu, Hepatitis B, Pneumovax
Cancer Screening: Colon, Pelvic Exam and Pap
Smear, Prostate, Mammogram
Bone Density Testing (every 2 years)
Cardiovascular Screening (lipids every 5 years)
Diabetes Screening (depends on risk factors)
AAA Screening/EKG (once – only with IPPE)
Glaucoma testing
STI and HIV Screening
Alcohol Misuse Counseling and Tobacco Cessation
Comparison Between USPSTF
Recommendations and Medicare
Coverage



Disparity between current USPSTF guidelines and
preventive services covered by Medicare.
USPSTF recommended against (D-rated) some
preventive services yet Medicare reimburses
physicians for these. Example, prostate cancer.
AWV uses USPSTF guidelines and ACIP
guidelines.
Lesser, Lenard et al, Ann Fam Med 2011; Vol 9, No 1, pg 44-49
Subsequent AWVs






HRA
Updated medical and family history
Update list of current providers and suppliers
Physical Exam (BP, Height, Weight, BMI or waist
circumference)
Update written screening schedule and list of risk
factors and medical conditions which require
interventions
Provide personalized health advice and referrals for
health education and preventive counseling
Subsequent AWVs
What is Different from Initial AWV?

Depression Screen – Unique to Initial AWV but
still addressed in the HRA.

Functional Ability – hearing, ability to perform
ADLs, fall risk, home safety. Unique to Initial
AWV but still addressed in the HRA.
Advance Planning

NOT required for either the initial or
subsequent AWV.

Optional to discuss and include during visit.
Annual Wellness Visit Screening Tests
Anne Phelps, MD
Assistant Professor of Medicine
Duke University Medical Center
Page 65
Depression Screen
Patient Health Questionnaire PHQ2
Over the last 2 weeks, how often have you been bothered
by any of the following symptoms?
Not at
all
Several
Days
More than
Half the Days
Nearly
Every Day
Little interest or pleasure in
doing things?
0
1
2
3
Feeling down, depressed
or hopeless?
0
1
2
3
Page 66
PHQ2



The PHQ2 is scored from 0-6.
A score > 3 had a sensitivity of 83% and a
specificity of 92% for major depression.
Higher scores correlate with:
 A decrease in functional status
 An increase in symptom-related difficulty
 Sick days from work
Source: Medicare 2003 Nov;41(11):1284-92.
Page 67
Depression Screen

If your PHQ2 is positive with a score greater than
3 you could consider screening the patient with a
PHQ9.

The PHQ9 is a set of nine questions scored the
same way as the PHQ2.

The PHQ9 gives guidance on treatment and
therapy options.
Page 68
Depression Screen
Over the last 2 weeks how often have you been bothered by any of the following
symptoms?
1. Little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless?
3. Trouble falling or staying asleep, or sleeping too much?
4. Feeling tired or having little energy?
5. Poor appetite or overeating?
6. Feeling bad about yourself or that you are a failure or have let yourself or your
family down?
7. Trouble concentrating on things, such as reading the newspaper or watching
television?
8. Moving or speaking so slowly that other people could have noticed? Or the
opposite being so fidgety or restless that you have been moving around a lot
more than usual?
9. Thoughts that you would be better off dead or of hurting yourself in some
way?
Page 69
Scoring the PHQ9
PHQ-9
Depression
Severity
Treatment
0-4
None-minimal
None
5-9
Mild
Watchful waiting
10-14
Moderate
Consider counseling
+/- pharmacotherapy
15-19
Moderately Severe
Pharmacotherapy +/- psychotherapy
20-27
Severe
Pharmacotherapy + Mental health specialist
for psychotherapy +/- collaborative
management
Page 70
PHQ9 Sensitivity and Specificity
The PHQ9 has a sensitivity of 0.77 (0.71-0.84).
The PHQ9 has a specificity of 0.94 (0.90-0.97).
This was in an unselected group of primary care
patients.
Gen Hosp Psychiatry 2007 Sep-Oct;29(5):388-95.
PRIME-MD
Pfizer website to download the PHQ9.
.
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and
colleagues, with an educational grant from Pfizer Inc. No permission required to
reproduce, translate, display or distribute
Page 71
“You need to get your cholesterol where your sperm count is.”
Page 72
Hearing Test
Whispered Voice Test
1. Stand one arm’s length behind
the patient.
2. Occlude the opposite ear
3. Exhale before speaking.
4. Whisper a combination of 3
numbers and letters (4, S, K).
5. If the patient responds
incorrectly, then repeat using a
different number letter
combination.
6. Test each ear separately.
Page 73
Whispered Voice Test



The test is normal if the patient repeats at least 3
of a possible 6 numbers or letters correctly.
The sensitivity is 90% and the specificity is 7087% for this test.
If the test is abnormal, refer to audiology for
formal hearing testing and hearing aid
evaluation.
Sandi Pirozzo, Tracey Papinczak, Paul Glasziou, BMJ. 2003 October 25;
327(7421): 967. 10.1136/bmj.327.7421.967
Page 74
Mobility and Fall Screening Tool
Timed Get Up and Go Test
On the word “Go” time the patient to do the
following:
1.
2.
3.
4.
5.
Stand up from the chair
Walk 3 meters in a line
Turn around
Walk back to the chair
Sit down
Normal result: < 10 seconds
Abnormal result: >20 seconds
Page 75
Timed Get Up and Go Test
Score: Balance function was scored on a five-point
scale:
1 = normal;
2 = very slightly abnormal;
3 = mildly abnormal;
4 = moderately abnormal;
5 = severely abnormal.
Patients with score of 3+
are at risk for falling.
Mathias, S., Nayak, U.S.L., & Isaacs, B. (1986). Balance in the elderly
patients: The "get-up and go" test. Archives of Physical Medicine and
Rehabilitation, 67(6), 387-389.
Page 76
Treatment for abnormal results?
1. Refer to physical therapy
for gait training, which
focuses on balance and
resistance training.
2. Consider OT evaluation
for mobility devices and
walkers.
3. Suggest Calcium and
Vitamin D
supplementation.
4. Screen for osteoporosis.
5. Falls risk prevention:
Page 77
Falls Risk Prevention




Remove rugs and small
objects
Increase lighting
Add grab bars and
handrails
Evaluate medications:
1.
2.
3.


Benzodiazepines
Antidepressants and
neuroleptic agents
Hypertension
medications
Avoid physical restraints
Avoid immobility
Page 78
Page 79
Memory Test:
The Mini Cog
1. Ask your patient to remember 3
unrelated words and repeat them
back to you.
2. Ask your patient to draw the face
of a clock on a sheet of paper with
a clock circle already drawn on the
page.
3. After they have drawn the clock
face, ask them to draw a specific
time like 10:10.
4. Ask the patient to repeat the three
stated words.
.
Page 80
Borson S. The mini-cog: a cognitive “vitals signs” measure for dementia screening in multilingual elderly Int J Geriatr Psychiatry 2000; 15(11):1021.
Page 81
What can we do with abnormal
Mini Cog results?
1. Evaluate the degree of dementia Folstein Mini
Mental Status Exam (MMSE)
2. Evaluate for cerebral vascular disease, delirium, or
depression which can mimic dementia.
3. Evaluate for metabolic causes like B12, thyroid,
folate, iron or copper abnormalities.
Page 82
Katz Index of ADL
Activities
Independence
Dependence
Bathing
1
0
Dressing
1
0
Toileting
1
0
Transferring
1
0
Continence
1
0
Feeding
1
0
Total Score
__________
Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970) Progress in the development of
the index of ADL. The Gerontologist, 10(1), 20-30.
Page 83
Scoring the Katz ADL Screen
Total Score
Functional Status
5-6
Full function
3-4
Moderate impairment
0-2
Severe functional impairment
Page 84
Billing 101: How to Bill Correctly (and Stay
out of trouble!)
Bruce Peyser, MD FACP
Associate Professor of Medicine
Duke University Medical Center
Billing Issues and Guidelines
 Billing for AWV’s can be
straight forward, or
complex, depending on
what you do.
 Will review the guidelines.
 Will talk about how to do
this correctly.
Who can bill for the AWV?






Physician
Osteopath
Physician Assistant
Nurse Practitioner
Clinical Nurse Specialist
Medical Professional Team (can include a health
educator, a registered dietitian, nutrition
professional, or other licensed practitioner) working
under the DIRECT supervision of a physician.
 NOT medical assistants, certified nurses aides or
certified nursing assistants.
When Can You do the Annual Wellness
Exam?
 Mr. Smith enrolls in Medicare
on Jan 1, 2012.
 Eligible for a Welcome to
Medicare visit Jan 1 2012Dec 31, 2012.
 Schedules and gets his visit
May 1, 2012.
 Eligible for 1st Medicare
Annual Wellness visit May 2,
2013.
 Eligible for next Medicare
Annual Wellness visit April 3,
2014.
Does the AWV have to take place in a
physician’s office?
 NO it does not.
 If service is provided, the
following institutions and/or
sites can bill for it:
o
o
o
o
o
Hospitals
Skilled nursing facilities
Rural health centers
Federally qualified health
centers
Critical Access Hospitals
The Annual Wellness Visit Can Only
be Carried out Once per Year per Patient
(not per Doctor)
From a practical viewpoint, when should
one do an AWV??
1. Once a year.
2. Plan it/schedule it in
advance.
3. Block out enough time!
4. Do this when the patient’s
health status is stable.
5. Encourage patient to do HRA
prior to visit.
6. NOT when you are behind, pt
needs to use bathroom, has
long list of questions, and
new problems.
Coding for the Annual Wellness Visit
 G0438- AWV with personalized prevention plan
service (PPPS), first visit.
 G0439-AWV w/ PPPS, subsequent visit
Picking the ICD-9/10 code for the visit.
 A Diagnosis code must be reported on the claim,
but no specific single ICD-9 code is required for
the AWV.
 Could use V70.0, V70.8, or V70.9.
 “Any other valid, appropriate diagnosis code
would be acceptable.”
-Thomas Dorsey at CMS, from March
28, 2012 National Provider Call
Coinsurance, deductible,
and cost sharing..
1. Copayment or coinsurance, and the Medicare
Part B deductible are waived for the AWV.
2. Cost sharing will apply to the E/M service IF this
is provided also.
AWV 2012 National Payment Rates
CPT
G0438 (initial AWV)
G0439 (subsequent AWV)
RVUs
Payment
-4.74 Relative Value Units $155.89
$110.96
The AWV is a Preventative VisitIt is NOT a Routine Annual Physical Exam
 The AWV is NOT intended to
be a head to toe physical
exam!!!!
 Medicare does not cover
“complete annual exams”.
 Be wary about trying to cover
too much , in too short a time
period, with inadequate
documentation.
 To both physicians and
patients, this can be very
disappointing.
Can one bill for other services at the
same time as the Medicare Annual
Wellness Visit?
 YES, ONE CAN!!!!!!!
 What can be done??
o Medically necessary
diagnostic ECG. (93000)
o Prostate Exam. (G0102)
o Breast and Pelvic exam
(G0101)
o Screening pap smear
(Q0091).
o “Medically necessary”
o E/M services-(Be really
really, really careful!!!!!!!)
Adding E/M services to the AWV
-be careful!
 Medicare allows for payment of “Medically
Necessary” E/M services that are furnished at
same visit as AWV.
 When these are appropriate, add Modifier 25 and
use CPT code range from 99201-99215.
 Again cost sharing will apply to the E/M service.
How would you bill for an AWV with
complaints of a urinary tract infection??
CPT
G0438
99212-25
ICD9
V70.0
599.0 (UTI)
Non Covered Preventative Services
 Medicare non-covered preventative services may
also be billed with an AWV.
 Provider must issue an advance beneficiary notice
(ABN) to notify the patient that payment for the
additional preventative service will fall to the
beneficiary.
How to teach learners/colleagues
/residents how to carry out the AWV??
 Present at a meeting or
dinner.
 Demonstrate 1:1.
 Have templates readily
available especially with
EPIC users.
 Have any of you tried to
teach this?
 How did that work out?
Final Common Misconceptions
• The AWV covers a yearly
complete head to toe annual
exam.
• You can do the AWV in a brief
period of time.
• It’s ok to do the AWV when
there are lots of other medical
problems that are occurring.
• Information within the AWV
can be used to support the
level of care determination for
E/M service.
Important Links
Overview from CMS:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads//MM7079.pdf
Overview from ACP
http://www.acponline.org/running_practice/practice_management/payment
_coding/wellness.htm
Overview from AMA
http://www.ama-assn.org/ama1/pub/upload/mm/433/cpt-medicare-ps.pdf
Overview from Duke
http://www.dukehealth.org/health_library/care_guides/primarycare/medicare-resources/medicare-s-annual-wellness-visit
Important Links
ABC’s of providing the annual Wellness Visit
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads//AWV_Chart_ICN905706.pdf
Annual Wellness Visit
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads//Annual_Wellness_Visit.pdf
Health Risk Assessment (paper version from Dartmouth)
http://www.acponline.org/running_practice/practice_management/payment_
coding/medicare/hra.pdf
Health Risk Assessment (electronic version, from Dartmouth)
http://www.medicarehealthassess.org/
In summary…
 The Medicare Annual Visit is a relatively new
service that we can and should be providing to
Medicare beneficiaries.
 There is a proper time and place to do this.
 You can get help-consider this a team approach.
 Make sure your documentation is meticulous,
especially if you add E/M codes as well.
 Use this time to cover topics that you might not
otherwise address.