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- 1. 1 VITAMIN C 345 WHancock Ave Suite 202 Athens, GA 30601 (706) 658 • 6024 following the implementation of the Affordable Care Act (ACA), more elderly individuals are able to access care and preventive services needed to improve current and future health outcomes. One of the many services covered by Medicare is the Annual Wellness Visit (AWV) which serves as an opportunity to develop a personalized preventive care plan. These visits provide patients and physicians with the opportunity to craft a unique preventive care plan that will likely improve future health outcomes and care delivery. Medicare patients may receive this annual service free-of-charge and physicians may receive valuable reimbursement dollars if all specified requirements are met. In 2013, the estimated average reimbursement for physicians across the country for AWVs was $126.00. That year, only a reported 11 percent of patients eligible for an AWV participated, leaving an estimated $3.8 billion unclaimed. While some physicians understand the ben- efit of providing Annual Wellness Visits to all eligible patients, they may remain frustrated by the barriers to performing these visits. Other physicians may not understand the potential value in providing these services and may view them as a waste of practice time and resources. At Vitamin C, we work hard to not only improve care delivery and practice efficiency through our software, but also through informational materials that may help your practice improve its performance. This white paper details the requirements of Annual Wellness Visits and the potential value in maximizing your utilization of this Medicare service. Only a reported 11 percent of patients eligible for an AWV participated, leaving an estimated $3.8 billion unclaimed. Medicare ANNUAL WELLNESS VISITS
- 2. 2 With the introductionof a Medicare expansion following the passage of the ACA, Medicare covers an Annual Wellness Visit (AWV) providing Personalized Prevention Plan Services (PPPS) for beneficiaries who: • Are not within the first 12 months of their first Medicare Part B coverage period • Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months. • Medicare pays for only one first AWV (CPT G0438) per beneficiary per lifetime and pays for one subsequent AWV (G0439) per year thereafter. These beneficiaries can now partner with their physicians to develop highly personalized wellness plans and take part in many preventive screenings with no additional cost to them. CMS details the requirements for the initial and subsequent AWV, which is outlined in the tables below. Understanding Medicare Annual Wellness Visits Performing Annual Wellness Visits At the initial AWV, physicians must do the following: Administer Health Risk Assessment (HRA) Establish list of current providers and suppliers Establish the beneficiary’s medical/family history Review the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders Review the beneficiary’s functional ability and level of safety Assess basic health measurements (height, weight, BMI, blood pressure, etc. Detect any cognitive impairment the beneficiary may have Detection of any cognitive impairment, for purposes of this section, means assessment of an individual’s cognitive function by direct observation, with due consideration of information obtained by way of patient report, concerns raised by family members, friends, caretakers, or others. Establish a written screening schedule for the beneficiary (ex: checklist for next 5 years) Establish a list of risk factors and conditions for which the primary, secondary, or tertiary interventions are recommended or underway Furnish personalized health advice and a referral, as needed, to health education or preventative counseling service Initial Annual Wellness Visit
- 3. 3 At the subsequent AWV,physicians must do the following: Assess basic health measurements (height, weight, BMI, blood pressure, etc.) Detect any cognitive impairment the beneficiary may have Detection of any cognitive impairment, for purposes of this section, means assessment of an individual’s cognitive function by direct observation, with due consideration of information obtained by way of patient report, concerns raised by family members, friends, caretakers, or others. Update the written screening schedule for the beneficiary Update the list of risk factors and conditions for which pri- mary, secondary, or tertiary interventions are recommended or underway for the beneficiary Furnish personalized health advice and a referral, as needed, to health education or preventative counseling service Subsequent Annual Wellness Visit Use the following Healthcare Common Procedure Coding System (HCPCS) codes when filing claims for AWVs:: • G0438: Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit • G0439: Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit The AWV codes do not distinguish between new and established patients. The initial AWV is billed the first time a Medicare beneficiary receives an AWV that includes all of the services enumerated by CMS. The subsequent AWV code is reported for any patients who have previously received an AWV service, wheth- er at your practice or at any other practice. The Centers for Medicare & Medicaid Services (CMS) did not specify the ICD-9 codes that should be used. Individual Part-B contractors may designate specif- ic codes, but ICD-9 codes in the V70 range have typically been accepted. The AWV is not the same as a “routine physical checkup” that some seniors may get annually. Medicare does not cover these routine physicals. Based on 2013 data, the estimated average reimbursement for physicians across the country for AWVs was $126.00, with internal medicine and family practices making the most use of these visits. Through this service overall, physicians col- lected a total of approximately $448 million in 2013; however, only a reported 11 percent of patients eligible for an AWV participated, leaving an estimated $3.8 billion unclaimed. See the appendix for information, including how your state’s 2013 average reimbursement compares to the rest of the country and which pro- viders are benefitting most from AWVs.
- 4. 4 The emphasis thatthe ACA has placed on preventive services and long-term health outcomes can potentially benefit both the patient and the physician. By completing the AWV, the patient has the opportunity to review his or her health status with a physician. Once the patient’s health is assessed, a detailed Personalized Preven- tion Plan can be created and tailored to his or her unique needs. This plan will be updated and reviewed with each subsequent AWV. These appointments will serve as a guide to patients over the next five to ten years of care while also serving as valuable revenue opportunity for your practice. These visits allow physicians to gain a comprehensive overview of a patient’s current treatments and services, including those that take place outside of the physician’s own practice. This information can help the provider plan future screenings and services. It may also save the physi- cian time and money by eliminating the need for scheduling several different appointments to address a variety of needs. This saves time for the practice and offers the possibility of increasing revenue by allowing the practice to see more patients in a single day. The Benefit of Annual Wellness Visits These appointments will serve as a guide to patients over the next five to ten years of care while also serving as valuable revenue opportunity for your practice. How Vitamin C Can Help Although Medicare patients are eligible for one AWV each year, utilization of this service often remains low. Some physicians may be unsure of how to fulfill the requirements of each AWV while others may be unsure of how to identify and engage eligible patients for this service. Physicians may also be fearful of dedicating too much time to completing this process. This opportunity to im- prove patient health outcomes and to increase practice revenue is sacrificed due to these perceived barriers. By streamlining the patient recruitment and engagement process and by providing educational materials for physicians and patients, companies like Vitamin C can increase your practice’s utilization of these services. For more information about how Vitamin C can increase your utilization of Medicare Annual Wellness Visits, please visit www.getvitaminc.com. CMS Resource: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLN- Products/downloads/AWV_chart_ICN905706.pdf
- 5. 5 Appendix Vitamin C Source: Centerfor Medicare and Medicaid Services Internal Medicine* Family Practice* Nurse Practitioner General Practice Obstetrics/Gynecology Physician Assistant Cardiology Emergency Medicine Geriatric Medicine Other Provider Types Aggregate Top 10 Providers of Wellness Visits 1,954,005 1,235,815 97,106 51,962 59,129 44,298 18,793 17,323 15,682 57,375 3,551,488 $ 248,358,385 $ 156,203,417 $ 10,663,033 $ 6,880,849 $ 6,830,235 $ 4,924,791 $ 2,535,303 $ 2,193,541 $ 2,065,900 $ 7,423,776 $ 448,079,230 Internal Medicine and Family Practice are the two highest reimbursement providers. $ 127 $ 126 $ 110 $ 132 $ 116 $ 111 $ 135 $ 127 $ 132 $ 129 $ 126 PROVIDER TYPE BENEFICIARIES PATIENTS WHO COMPLETED AWV ELIGIBLE PART B MEMBERS MISSED REIMBURSEMENT STATE PAYMENTS PAYMENTS UTILIZATION AVERAGE PAYMENTS AVERAGE PAYMENTS Medicare Annual Wellness Visits AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY 2,797 44,122 31,395 90,462 300,542 54,930 80,711 6,981 12,763 307,543 118,183 2,779 32,393 17,394 143,847 72,604 30,631 39,949 $ 419,468 $ 5,363,577 $ 3,789,361 $ 10,921,219 $ 41,421,450 $ 6,655,274 $ 10,405,305 $ 954,481 $ 1,663,714 $ 39,080,969 $ 14,414,040 $ 361,349 $ 3,812,849 $ 2,023,640 $ 19,007,038 $ 8,592,206 $ 3,749,250 $ 4,753,563 $ 150 $ 122 $ 121 $ 121 $ 138 $ 121 $ 129 $ 137 $ 130 $ 127 $ 122 $ 130 $ 118 $ 116 $ 132 $ 118 $ 122 $ 119 68,241 662,002 434,581 588,695 2,921,258 416,364 414,254 62,121 145,352 2,207,095 952,033 101,324 441,844 166,489 1,617,921 799,358 375,926 592,779 4% 7% 7% 15% 10% 13% 19% 11% 9% 14% 12% 3% 7% 10% 9% 9% 8% 7% $ 9,814,683 $ 75,110,987 $ 48,664,353 $ 60,150,245 $ 361,193,630 $ 43,791,049 $ 43,000,539 $ 7,539,049 $ 17,283,570 $ 241,385,211 $ 101,699,458 $ 12,813,639 $ 48,194,815 $ 17,345,901 $ 194,774,873 $ 86,006,556 $ 42,264,278 $ 65,781,673
- 6. 6 PATIENTS WHO COMPLETED AWV ELIGIBLEPART B MEMBERS MISSED REIMBURSEMENT STATE PAYMENTS UTILIZATION AVERAGE PAYMENTS LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 25,177 172,354 69,730 26,339 162,797 22,037 67,622 27,549 16,555 159,640 6,442 16,338 25,307 134,180 17,229 21,344 219,857 84,612 25,566 26,612 99,084 28,666 68,637 6,933 89,077 244,584 16,703 107,599 9,810 66,797 79,598 10,820 4,506 $ 2,909,580 $ 21,954,400 $ 9,370,765 $ 3,019,139 $ 20,022,135 $ 2,662,999 $ 8,224,588 $ 3,203,694 $ 2,012,542 $ 18,644,670 $ 771,090 $ 1,929,598 $ 3,160,807 $ 18,323,674 $ 2,061,979 $ 2,774,394 $ 29,299,885 $ 10,164,588 $ 3,036,746 $ 3,281,156 $ 12,810,493 $ 3,547,945 $ 8,501,366 $ 848,016 $ 10,637,591 $ 29,400,490 $ 1,962,909 $ 14,109,511 $ 1,201,341 $ 8,534,362 $ 10,293,224 $ 1,277,978 $ 561,054 $ 116 $ 127 $ 134 $ 115 $ 123 $ 121 $ 122 $ 116 $ 122 $ 117 $ 120 $ 118 $ 125 $ 137 $ 120 $ 130 $ 133 $ 120 $ 119 $ 123 $ 129 $ 124 $ 124 $ 122 $ 119 $ 120 $ 118 $ 131 $ 122 $ 128 $ 129 $ 118 $ 125 504,543 842,239 705,251 221,201 1,227,316 383,648 750,490 440,103 148,204 1,240,199 91,536 241,604 213,451 1,079,504 221,897 248,090 1,863,149 1,170,145 502,984 360,860 1,312,710 109,348 653,551 116,586 754,047 2,223,893 188,349 974,388 106,412 702,935 609,142 285,502 79,950 5% 20% 10% 12% 13% 6% 9% 6% 11% 13% 7% 7% 12% 12% 8% 9% 12% 7% 5% 7% 8% 26% 11% 6% 12% 11% 9% 11% 9% 10% 13% 4% 6% $ 55,397,930 $ 85,329,746 $ 85,405,391 $ 22,336,283 $ 130,923,439 $ 43,697,853 $ 83,054,453 $ 47,976,219 $ 16,004,176 $ 126,200,612 $ 10,185,516 $ 26,605,024 $ 23,498,906 $ 129,093,817 $ 24,494,810 $ 29,473,518 $ 218,998,106 $ 130,406,990 $ 56,708,013 $ 41,211,477 $ 156,908,753 $ 9,985,882 $ 72,447,342 $ 13,412,303 $ 79,410,834 $ 237,925,022 $ 20,171,557 $ 113,662,475 $ 11,829,961 $ 81,276,585 $ 68,478,042 $ 32,443,386 $ 9,393,734 AGGREGATE: 3,550,127 $447,903,457 $126 33,540,864 11% $3,771,162,663 PATIENTS WHO COMPLETED AWV ELIGIBLE PART B MEMBERS MISSED REIMBURSEMENTPAYMENTS UTILIZATION AVERAGE PAYMENTS Vitamin C Source: Center for Medicare and Medicaid Services >