March 1, 2022
Annual Wellness Visits – Best Practice Tips
Annual Wellness Visits (AWV) are underused and are a critical component of the Patient Centered Medical Home and population health management.
The AWV provides an opportunity for physicians and providers to improve the quality of care, discuss and organize a care plan, engage the patient in their care, discuss diagnoses and preventative care measures, and optimize your revenue opportunity. Despite the possible benefits to both providers and patients, adoption of the AWV has been modest, with an estimated 24% of eligible beneficiaries receiving an AWV in 2017. (1) One study demonstrated that a first-time AWV was associated with a 5.7% reduction in total health care costs in the 11 months following the AWV, estimating a per-member per-month decrease of $81 in overall spending. Of note, patients in the highest-risk hierarchical condition category (HCC) quartile had the greatest reduction in costs for those attending an AWV relative to those who did not. (2)
The CPT codes for the AWV services are G0402 (IPPE – initial preventative physical exam), G0438 (initial visit after the IPPE) and G0439 (subsequent visit). Reimbursement is up to $173.70 for the IPPE, $173.70 for the AWV initial visit, and $117.71 for the AWV subsequent visit depending on the geographical region.
MPP has captured best practice tips from physicians and offices to support the performance of the AWV:
- Educating the patient on the value of and promoting the AWV prior to the AWV visit is important for achieving patient satisfaction.
- Gather information on patients aging into eligibility who are 64 years of age and eligible for the IPPE on their 65th birthday.
- Develop a personalized invitation from the physician/practice for the recruitment of eligible patients. (3)
- An AWV can be performed in the same month the following year, for example, if an AWV is completed on June 30, 2021, the patient is eligible for an AWV starting on June 1, 2022. (4)
- Medicare does not cover a full physical exam (99387 or 99397), convert the Medicare physical exam to an AWV on the practice schedule.
- Research alternative methods and processes for completing the AWV- Virtual Care, AWV nurses.
- Document and code for any active condition during the Annual Wellness Visit. Cerner allows 16 diagnoses and unlimited CPTII codes on their claim.
- Don’t forget the add-ons – when you perform the AWV, utilize the CPT II codes, for example, smoking cessation counseling (4000F), or use of ACE/ARBS (4010F).
- Many of the Medicare and Medicare Advantage Plans have a quality measure for the completion of the AWV.
- AWV can be a tool for patient attribution to our McLaren ACO which helps to mitigate risk as we are now in downside risk.
Medicare Annual Wellness Visits are associated with lower healthcare costs as well as improved clinical care and quality for our beneficiaries. (5)
References:
#1. Misra A, Lloyd JT. Hospital utilization and expenditures among a nationally representative sample of Medicare fee-for-service beneficiaries 2 years after receipt of an annual wellness visit. Prev Med. 2019; 129:105850. doi: 10.1016/j.ypmed.2019.105850
#2. Beckman AL, Becerra AZ, Marcus A, et al. Medicare annual wellness visit association with healthcare quality and costs. Am J Manag Care. 2019;25(3):e76-e82.
#3. Daniel Bluestein MD, Medicare Annual Wellness Visits: How to Get Patients and Physicians on Board, FPM, March-April 2017.
#4. Mike Linnert, Physician Practice, Four best practices for your Annual Wellness Visit engagement campaigns, August 26, 2021.
#5. American Journal of Managed Care, March 8, 2019, Medicare Annual Wellness Visit Association with Healthcare Quality and Cost, Adam Beckman BS et al.