Medicare Wellness Visit

Transcription

1 Medicare Wellness Visit Jessica Masser, MS, DO, MSMedEd, FAAFP, FACOFP January 25, 2018 Outline What are they? Why we do them? Patient care Quality markers Components Suggested work flow Billing and coding Wellness Exam For every adult periodically During regular visits Medicare brand NO COPAY COLLECTED Done all at one visit Other insurances including Medicaid cover January 25 28,

2 Exam Types Welcome to Medicare Within first 12 months of enrollment Initial Annual Wellness Visit If Welcome visit not done Subsequent Annual Wellness Visit 12 months after first AWV Wellness Exam Difficulties Takes time Comprehensive exam Multiple steps Specific components must be completed Integration at problem-oriented visits Not paid for additional work Solution Allowed prevention to be moved to a single visit, with pay Wellness Exam Purpose Screening Detect current problems or risk for future History Labs and radiology Minimal physical exam Education Recommendations Wellness behaviors Chemoprophylaxis Immunizations, etc January 25 28,

3 Quality Measure Used as a guide for quality care provided to the elderly Increase per person revenue Increase overall score Ex: STARS program When, Where and Who Timing per year is based on each individual carrier Highmark Calendar year UPMC Yearly (12 months apart) When, Where and Who Setting Office SNF Personal Care Home Hospital in theory January 25 28,

4 When, Where and Who Any provider Physician CRNP PA-C PharmD Nurses Staff Past medical history Surgeries Current Meds and supplements Family History Social History Alcohol, tobacco and illicit drug use Diet Physical Activity NOTE: if these have already been done recently it is only necessary to review or say no change Depression Screen Instrument recognized nationally Easiest is to use 2 standard questions In the last 2 months have you frequently: Been sad or depressed Had less interest in doing things you like to do If yes to either then a more thorough history is necessary No specific guidelines are provided January 25 28,

5 Review of functional ability and level of safety Use direct observation Any screening designed for this purpose and recognized by national professional organizations Assess Hearing impairment ADLs/IADLs Fall risk Home safety? A bit ambiguous? Hearing impairment Do you have trouble hearing or have others said so? If positive a more complete history is needed Hearing test is required at Welcome & Initial Activities of daily living Asking if there are any difficulties with ADLs & IADLs If any positives a full ADL/IADL inventory is necessary Fall Risk In the last year, history of previous falls and worry about falls is enough Incontinence inquiry Home Safety Review Ask patient and family, if present, about unsafe conditions If positive then should provide a home safety checklist January 25 28,

6 Cognitive Impairment Screen Ask about trouble with memory or if others have concerns If family is with patient, best to ask them also Listing of all other providers and suppliers Determine what preventive tests and immunizations have already been done and when Prepare prior to visit Will need to plan for completion Physical Exam Requirements Vitals Weight Height BMI Blood pressure Vision Exam Hearing Exam Basic Gait Exam Get Up and Go Basic Cognitive Impairment Screen No need to do anything else and best not to January 25 28,

7 Physical Exam Requirements Vision Exam Skip if documented recent eye exam Snellen Hearing test Basic Gait Exam Get up and go test Stand from an armed chair, walk 10 ft, turn around, walk back and sit down Fall risk is generally significant if > 20 sec Cognitive Impairment Screen No specific test is dictated A general feel from talking to the patient If positive a more thorough evaluation is needed Not Required!! Best not to do Chief Complaint/Problem ROS (other than items mentioned) Full PE Actual giving the immunizations or ordering the labs or radiology Clinical decision Patient wants it then & understands the cost Provider knows they may not get another opportunity Testing Requirements Must advise patient about all indicated preventive items Paid for by Medicare Advised by USPSTF Advisory Committee on Immunization Practices (ACIP) Due in the next 5-10 years Procedures, Radiography, Labs, Immunizations, Counseling January 25 28,

8 EKG Not required, but is a covered option once Only with Initial Exam (Welcome exam) Deductible and Co-pay apply Other Requirements Education/Advice Establishment of a list of risk factors/conditions Preventive interventions should be recommended Examples Mental health Weight loss Physical activity Smoking Fall prevention End of Life/Advance Directives Discussion or Review not required Wise to briefly screen Simply If you haven t done the paperwork for Health Care Power of Attorney and Living Will, I highly recommend you do. We have the forms January 25 28,

9 Requirement All recommendations must be in WRITING personalized health advice and referral Must provide documentation that all requirements were done Medicare does audits and gives penalties if incomplete exam was done Hidden Costs Some recommended interventions are NOT free Deductible/Co-pay Immunizations Intervention during screening Polypectomy during colonoscopy Labs Diabetes self-management EKG Glaucoma Screening How to Keys Scheduling the appointment Do at time of a problem visit Encourage patients to make appointment Office ads, flyers, letters Incentives from the insurance Gift cards, etc. Highly suggested option? Book 2 appointment slots January 25 28,

10 How to Keys 2 forms required can be electronic Patient History Questionnaire Patient Education Form Lists all advised interventions for next 5-10 years Can be helpful: Provider Checklist To document a summary that all requirements were met All documentation needs to be in the record Scanned into EMR Placed in the patient file How to Keys Prepare staff Team event Prepare patient before the exam room State at the time of scheduling Provide education letter Purpose and problems not covered Staff state, you are here today for your MWV Prepare physician Know Health Maintenance like an expert Know before entering exam room that it is MWV Game Time Front desk Schedule patient 30 minutes (?) do not overlap Clearly state Medicare Wellness Visit Explain NO COPAY FOR THE VISIT ONLY Prep for no problems If a problem is identified then what? January 25 28,

11 Game Time Triage Vitals Visual Acuity Or documentation of recent eye exam Hearing test History questionnaire Patient advised of purpose & scope of visit Have form, template, checklist, POA papers all ready Perform get up and go test Game Time Physician Confirm agenda Complete or update FH and SH Review Med List Review questionnaire Review vitals Perform cognitive impairment screening Option Very brief cardiac and lung exam If increased skin cancer risk, consider skin exam Complete the Patient Education checklist Finalize what specifics will be done today Game Time Physician Diagnostic Codes Z00.00 Billing Codes Welcome G0402 Initial G0438 Subsequent G0439 January 25 28,

12 But They re Sick Two visits can be billed but watch Separate identifiable condition/problem All components for E&M level needed Cannot bill two visits for refills, routine monitoring of existing condition, ordering labs Try to judge based on when the condition was found Identified at check-in Identified during triage/rooming Identified during provider portion But They re Sick Try to judge based on when the condition was found Identified at check-in Do NOT do AWV convert to regular visit Identified during triage/rooming Could be possible to do 2 visits Identified during provider portion Likely two visits Does increase audit potential for frequent two visit bills Wrap Up Covered service through all Medicare carriers Beneficial to you and the patient Specific items required Gray zones about some requirements Have a process to make it a habit Ensure you are coding correctly Remember these are intended to provide good quality patient care January 25 28,

13 References Medicare.gov. accessed last 1/15/2018. MedicareInteractive.gov. accessed last 1/15/2018. CMS.gov. Learning-Network- MLN/MLNProducts/downloads/AWV_chart_ICN pdf, accessed last 1/15/2018. January 25 28,