Medicare Wellness Visits - Everything in one place!
Our Medicare Annual Wellness Visit (AWV) process changed right before Covid came along 😊
This email details some of the changes now that we are also doing virtual visits. We will review these processes with everyone multiple times so never fear if you need to review this more than once. If you have questions, please let me or your supervisor know!
Attachments to this email –
In person Annual Wellness Visit information – Scheduling, Rooming and Provider (Express Lane)
Virtual Annual Wellness Visit without PDL
Virtual Annual Wellness Visits with or without Outpatient Care Technician (OCT=Mirela for our clinics who can prep the AWV)
Pearls for Annual Wellness Visits
Important things to note:
How do we do the Health Risk Assessment (HRA) now that we are no longer using our old paper forms?
The Health Risk Assessment for patients is now being done in Epic in one of 3 ways.
- Asked and entered into Epic by the MA
- Done on paper by the patient/entered by the MA (we are getting a paper copy of the HRA questions to be given in the waiting room)
- Done on the portal by the patient or Outpatient Care Coordinator/imported by the MA.
MA can click "File All" to file the patients responses
How do you get the correct Rooming Tabs (with HRA) and Express Lane for AWV?
Medicare AWV Express Lane opens when the visit is scheduled with Visit Type ANNUAL WELLNESS VISIT-MEDICARE OR the Reason for Visit in Rooming is Medicare Wellness Visit.
IMPORTANT for MAs: For virtual AWV visits the MA needs to enter the reason for visit as Medicare Wellness Visit and the Health Risk Assessment tab will appear in the rooming header
Click F5 or close the chart and re-open the chart after the reason for visit was entered to pull the activities into Rooming.
What is a PDL?
PDLs are a paper list of Risk-adjusting diagnoses for individual patients with Humana Medicare Insurance. This is scanned under the Media tab and should be printed for the provider to complete during the AWV.
Providers should bill/address any relevant diagnoses in their note and complete the form which is then scanned back into Epic by your MA using a specific process.
There is special reimbursement for doing the form correctly
We are working on a process to complete the form remotely so it can be done w a Virtual visit.
How do I bill for AWVs?
Medicare Fee For Service
- 11 months must have passed between the appts
- IPPE G0402 – Billable in the first 12 months of Medicare (different template)
- AWV G0438 - Billable once in a lifetime at least one year after part B effective date
- AWV G0439 - Billable every year after initial AWV
- Preventive physical CPT code 99381-99397 is not covered (Do Not Bill)
- Ok to bill for additional services ex: 99213 if patient is requesting additional services as long as documentation supports it. Need to notify the patient that there would be additional charges for these services.
Medicare Advantage
- Services performed per calendar year
- IPPE G0402 – Billable in the first 12 months of Medicare (different template)
- AWV G0438 - Billable once in a lifetime at least one year after part B effective date
- AWV G0439 - Billable every year after initial AWV
- Preventive physical CPT code 99381-99397 is covered and encouraged to billed at same time
- For PHP (United West) patients – DO NOT bill all 3 - AWV plus preventative physical plus 99213/4
Beth Groff, MD
Associate Program Director, 84th Ave Neighborhood Health Center
St. Anthony North Family Medicine Residency
2551 W. 84th Avenue
Westminster CO 80031
Office: 303-430-6017 | Cell: 720-301-1171 | Fax: 303-430-6001
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