Medicare Wellness What is it, and how can I u1lize this in my prac1ce? Rural Health Clinic Conference Jackson, MS

Transcription

1 Medicare Wellness What is it, and how can I u1lize this in my prac1ce? Rural Health Clinic Conference Jackson, MS Brad Crosswhite, M.D., FAAFP Central Regional Medical Director ACO Medical Director Population Health Physician Leader North Mississippi Medical Clinics, Inc.

2 Objec:ves Iden&fy the challenges of performing the Annual Wellness Exam Differen&ate between different types of Annual Wellness visits Learn how to teach staff to schedule the Annual Wellness visit Consider a best prac&ce model that uses a collabora&ve team-based approach Learn how proper documenta&on, coding, and billing maximizes reimbursement

3 Medicare Wellness The Affordable Care Act (ACA) offers Medicare beneficiaries wellness services with no co-pay or deduc&ble. The Ini&al Preven&ve Physical Exam (IPPE) and an Annual Wellness Visit (AWV) are at the core of these covered screening services offered by CMS. Beneficiaries receive: Important cancer screenings Depression Screening Screening for early detec&on of chronic disease Personalized Preven&on Plan that takes into account past medical history, func&onal capacity, social factors, and health maintenance recommenda&ons for the next year.

4 Medicare Wellness Visits Establish patient relationships with PCP or team Promotes preventive care away from their active medical problems Incorporates public health screenings Meets quality metrics for CMS Identifies high risk patients for Care Coordination 2+ Chronic Diseases Identifies patients at risk for developing chronic diseases and enables early interventions for prevention Attribution of patients to your ACO Provides new revenue stream for clinicians

5 Approach Iden&fy the challenges of performing the Annual Wellness Exam (Why aren t we doing them already?) Differen&ate the types of Annual Wellness Exams (What do we need to know to make this a success?) Develop training curriculum for staff to include: Scheduling process Verifying eligibility prior to the appointment Accurate documenta&on of services provided Develop a best prac&ce model that uses a collabora&ve approach Iden&fy how to maximize reimbursement through proper documenta&on, coding, and billing (Offer the exam during an exis:ng appointment-- pa:ents don t want to come back!!)

6 How We Do It Eligibility Don t just guess if your pa&ent is eligible Navicure is the system we use at NMMCI

7 Internal Communica:on Worksheet handoff to nurse Worksheet handoff to front desk staff Communica&on board HRA given to pa&ent at check in to complete Nurse starts correct Centricity encounter Nurse and Provider educa&on Quick Reference Cards

8 Medicare Wellness Visits are stupid easy Donald Robertson, DO Iuka Medical Clinic Physician IT Development Crea&on of 2 different encounters Welcome to Medicare (IPPE- Ini&al Preven&ve Physical Examina&on) Medicare Annual visit Smart forms through EHR integra&on Posi&ve findings addressed in one loca&on for provider to address No need to review the ini&al HRA

9 Nurses documenta&on creates ac&on items for provider to address.

10 Making it work for the pa:ent Addi&onal Instruc&ons can be entered here, specific to each pa&ent Provider prints Personal Preven&on Plan (PPP)

11 Personalized Preven:on Plan (PPP) Provider Engagement: Essen&al for communica&ng personal goals for our pa&ents.

12 What about the new G codes? Smoking Cessa&on Depression Screening (PHQ-9) IBT Advanced Care Planning Alcohol Misuse/Abuse

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14 Nurse Intake HRA

15 G0444 Depression Screening $16.56

16 Intensive Behavioral Therapy for Cardiovascular Disease: Annual All pa&ents with hypertension, hyperlipidemia, advancing age, and other known risk factors for cardiovascular and other chronic diseases Nurse and provider spend 8 minutes on counseling

17 Provider Health Screening Page G0446 CV IBT $24.50

18 99497 ACP $80.65

19 Annual Alcohol Misuse Screen / Counseling If screen is posi&ve, providers can charge for counseling.

20 Provider Health Screening Page 1. G0443 Counseling $

21 Coding and Reimbursement 100% internal audi&ng of IPPE/AWV exams for completeness and accuracy of documenta&on of services provided Provider documenta&on educa&on post wellness exams if documenta&on not compliant/consistent with services provided Must ensure that we are comple&ng requirements designated by CMS to care for pa&ent and document medical necessity

22 Results Welcome to Medicare/ Annual Wellness Visit 120% 100% 100% 90% 80% 60% 75% 71% 69% 69% 69% 65% 57% 45% 40% 20% 0% Barnes Crossing MC Iuka MC Fulton MC Tupelo IMA Baldwyn MC West Tupelo MC Booneville MC Sal&llo MC Ecru MC Maben MC Welcome to Medicare/Annual Medicare Visit

23 Results North MS Medical Clinics Medicare Wellness Visits Total Charges Total Encounters $1,800,000 14,000 $1,600,000 $1,444, $1,532, ,805 $1,558, ,104 12,000 $1,400,000 TOTAL CHGS $1,200,000 $1,000,000 $800,000 9,729 10,000 8,000 6,000 # ENCOUNTERS $600,000 $400,000 $353, $533, ,499 4,000 $200,000 2,289 2,000 $0 FY12 FY13 FY14 FY15 FY16 *** 0

24 Best Prac&ce Sharing U&lize and leverage EMR to automate entry and u&liza&on of data Develop and hardwire workflow within each clinic that are consistent Improve communica&on with employees to ensure that each available visit is captured Increase encounters for providers through pa&ent outreach

25 Thank You! Ques&ons?? Contact me at: Brad Crosswhite, M.D., FAAFP Central Regional Medical Director Physician Leader for Clinic Growth Population Health Physician Leader North Mississippi Medical Clinics, Inc.