CMS now offers a variety of preventative services including the Annual Wellness Visit and as this service grows in popularity, it is important that your healthcare organization is in compliance with Medicare’s guidelines. Do not let non-compliance prevent you from offering this valuable service to your Medicare patients.

The Center for Medicare & Medicaid Services (CMS) recognizes the crucial role that health care providers play in educating Medicare beneficiaries about potentially life-saving preventive services and screenings, and in providing these services[1].

For dates of service on or after January 1, 2011, Medicare covers an AWV providing Personalized Prevention Plan Services (PPPS) at no cost to the beneficiary, so beneficiaries can work with their physician to develop and update a personalized prevention plan. This benefit provides an ongoing focus on prevention that adapts as a beneficiary’s health needs change over time[2].

The AWV is a preventive wellness visit and is not a “routine physical checkup” that some seniors may get every year or two from their physician or other qualified non-physician practitioner. Medicare does not provide coverage for routine physical examinations[3].

Question: Are you correctly performing the Annual Wellness Visit and are you in compliance?

During this 30-minute screening visit, you must review the patient’s HRA, establish a medical/family history, take vitals, detect cognitive impairment, review potential risk factors, perform a functional capacity evaluation, safety analysis as well as a Depression and Anxiety screening.

Based on the results of these screenings, you must develop:

– A Risk Factor analysis
– Written Screen Plan for the next 5 – 10 years
– A Personalized Health Advise document

These reports must be attached to the patient chart to successfully pass a CMS audit. Medicare may assess penalties for non-compliance with their statutes.

Risk Factor Analysis

Risk Factors show the relative value of each chronic condition which must be identified during the Annual Wellness Visit. The identification of these Risk Factors will allow the physician to pursue treatment options and face-to-face encounters and develop a care plan.

Written Screening Schedule

The Written Screening Schedule is a mandatory document that shows the plan of care for the patient over the next 5 to 10 years. It must be updated annually, as the patient receives their Annual Wellness Visit, and as appropriate. It is based on recommendations of the USPSTY and Advisory Committee of Immunizations, the patient’s health status, and screening history, as well as age-appropriate preventive services covered by Medicare.

Personalized Health Advice

A Personalized Health Advice document is to be developed, based on the Annual Wellness Visit and given to the patient to help them manage their wellness. This document includes advice pertaining to referrals, health education, or preventative counseling services. It also should promote self-management and wellness in areas such as weight loss, physical activity, tobacco-use cessation, fall prevention and nutrition.

Subsequent Annual Wellness Visit Requirements

The following must be completed during subsequent Annual Wellness Visits:

– Updated HRA
– Update patient’s medical/family history
– Update patient’s medical providers and supplies as list in Initial AWV
– Vitals and patient’s measurements
– Cognitive Impairment Assessment
– Depression and Anxiety Analysis
– Updated Written Screening Schedule
– Updated Risk Factor Analysis
– Updated Personalized Health Advise

Documentation

Medical records must document that a health professional provided, or provided and referred, all required elements of the AWV. You should use appropriate screening tools normally used in a routine physician’s practice.

If you also perform a significant, separately identifiable medically necessary Evaluation and Management (E/M) service, this must be documented in the medical record and include all referrals and a written medical plan in this documentation.

For information on recording the appropriate clinical information in the beneficiary’s medical record, refer to the “Documentation Guidelines for Evaluation and Management (E/M) Services” for 1995 and 1997 at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/EMDOC.html on the CMS website[4].

Who Can Perform the Annual Wellness Visit?

The AWV must be furnished by a health professional, meaning:

– A physician;
– A physician assistant, nurse practitioner, or clinical nurse specialist; or
– The AWV may be furnished by a medical professional (including a health educator, a registered dietitian or nutrition professional, or other licensed practitioner) or a team of such medical professionals, working under the direct supervision of a physician[5].

WellTrackONE will help ensure that you are in compliance and provide you with the services and software to complete this valuable visit for your eligible Medicare patients. Contact Bill Archer, barcher@welltrackone.com for a 15-minute demonstration to learn how.

[1]DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services – Providing the Annual Wellness Visit (AWV) – ICN 907786 Page 2
[2] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services – Providing the Annual Wellness Visit (AWV) – ICN 907786 Page 2
[3] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services – Providing the Annual Wellness Visit (AWV) – ICN 907786 Page 3
[4] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services – Providing the Annual Wellness Visit (AWV) – ICN 907786 Page 8
[5] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services – Providing the Annual Wellness Visit (AWV) – ICN 907786 Page 3