MEDICARE ANNUAL WELLNESS VISITS

Are You Maximizing Your Medicare Annual Wellness Visits (AWVs)?

Many clinics aren’t performing Medicare Annual Wellness Visits (AWVs) as CMS designed them. Some mistakenly treat AWVs as annual physicals—but they are not.

Per CMS guidelines, an AWV is a record-keeping visit and does not require a physician, NP, or PA. It can be fully performed by a licensed nurse (LVN, LPN, RN).

Required Elements of an AWV

To comply with Medicare guidelines, all of the following must be completed during an AWV:

Update the Health Risk Assessment (HRA).
Update the patient’s medical and family history.
Update the patient’s current medical providers, suppliers, and prescribed medications.
Record routine measurements, including height, weight, BMI, blood pressure, and other relevant metrics.
Assess the patient’s cognitive function. Medicare requires testing for cognitive deficiencies or impairments—yet many clinics skip this step, leading to repayment demands following audits. (We have a dedicated page covering Cognitive Testing in detail.)
Provide a printed screening schedule for the next 5 to 10 years. This should include screenings recommended for the general population and any additional screenings based on the patient’s risk factors.
Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.
Furnish personalized health advice and appropriate referrals to health education or preventive services.

Many clinics fail to meet all of these requirements, particularly cognitive testing and providing a printed screening schedule. Fortunately, most EMR systems offer simple ways to generate this information.

AWVs Can Be Extremely Profitable

When performed correctly, AWVs can be a highly profitable service for your practice. The best approach depends on your workflow:

If the doctor prefers to see the patient, we can show you how to streamline the process, ensuring the patient completes most of the HRA in advance.
If you’d rather have the nurse handle everything, we can guide you through that process as well.

Want to Increase Your Practice’s Revenue?

We tailor our approach to your needs and workflow. Give us a call, and we’ll show you how AWVs can generate revenue you may be missing—without adding extra burden to your providers.

PROFITABILITY OF THE AWV

Most clinics performing the AWV are billing the codes G0438 or G0439 only and their income averages about $130 per Medicare annual wellness visit

Clinics following our advice usually see the AWV generating $310 to $470 per Medicare AWV, by performing what Medicare expects during the Annual Wellness Visit.

WHAT IS REQUIRED IN THE AWV

1. Update the Health Risk Assessment

2. Update the individual’s medical and family history.

3. Update the individual’s current medical providers and suppliers and all prescribed medications.

4. Record measurements of height, weight, body mass index, blood pressure and other routine measurements.

5. Assess the patient's cognitive function.

6. Update and provide printed screening schedule for the next 5 to 10 years including screenings appropriate for the general population, and any additional screenings that may be appropriate because of the individual patient’s risk factors.

7. Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.

8. Furnish personalized printed health advice and appropriate referrals to health education or preventive services.

LET US HELP YOU

As part of our one hour online, live analysis with your medical provider, your manager and your billing person, we'll go over the steps in detail as to what is required in the AWV, how to complete it in your office and, among other revenue producing services show you the profitability of the AWV.

Give us a call at 903 871-1172 or email us at donself@donself.com and let us schedule it for you. Remember - if that call doesn't help you increase your clinic income by at least $100,000 per year - you pay us nothing for that consultation.

HOW MUCH INCOME CAN THE CLINIC GET?

That answer depends on whether you're willing to work smart or whether your doctor or medical provider insists on continuing to work harder instead of smarter.

A clinic with 1,000 Medicare patients (Part B & Advantage Medicare) should be averaging about 3.8 Medicare AWVs a day. If you're doing what we recommend, that's about $286,750 a year in AWV income.

This includes the income from you following our advice on performing Cognitive Testing during the AWV, which increases the profit of the AWV by another $53 to $262 on average - making the AWV income between $320 and $560 overall. For more information on Cognitive Testing - see our Cognitive Testing Page.

CAN WE BILL THE ALCOHOL & DEPRESSION SCREENINGS ALSO?

HCPC code G0438 (initial AWV) includes the depression screening, so you can't bill the G0444 (depression screening) along with the G0438, but you CAN bill the G0444 along with the G0439 (subsequent AWV).

Keep in mind that the Alcohol Misuse Screen (G0442) and Depression Screening (G0444) codes are TIMED codes and as such, you're required to document that at least half of the 15 minutes per code was spent. In other words, to bill G0442 for alcohol misuse screens, you better document that at least 8 minutes was spent on that service. Yes, it's about $19 in Medicare allowed (which Medicare pays 100% of), but you can't bill it if you only spent 3 minutes asking the patient how often they drink alcohol and the patient says "never". The burden of proof is on the clinic to prove they spent at least 8 minutes (more than half of the 15), so make sure whomever is doing it - documents the time.

COMMON QUESTIONS ASKED

Q. We don't have a nurse. Can our M.A. perform the AWV?

A. There are some that says their MAC said an M.A. can do it, but I've NEVER seen anything official supporting that. Everything I've seen from CMS has said that only licensed personnel can perform the AWV and an M.A. is not licensed. They may be credentialed - but not licensed. So, if you have an M.A. doing it, I highly recommend you have the physician or NP or PA (or whichever provider is billing it under their provider number) enter the room and go over the 5-10 year screening schedule with the patient as they hand the patient their printed reports. So, while a nurse can do 100% of it without the doctor seeing the patient, the MA needs the doctor or NP to be involved to some degree and see the patient on the day of the AWV

Q. Our doctor always bills an office visit along with the AWV, so our income averages around $200 or more. Is this legal?

A. Most offices are under the impression that the doctor should take care of "problems" during the AWV, yet that is NOT what the AWV is for. The AWV is a record-keeping visit designed to help PREVENT problems - not treat those the patient already has. I see doctors documenting the HPI or exam or ordering labs or performing EKGs at the AWV. That tells me the provider believes the AWV is an annual physical - WHICH IT IS NOT. Yes - if you're doing a sick visit or treating a problem or condition during the AWV, you should bill an office visit with it. It is appropriate.

Q. We schedule our NP or PA to perform all of the AWVs since they can address the chronic issues during the AWV.

A. You can do this, but why pay an NP or PA $65 an hour to do something that you can be paying an LVN or LPN $20 an hour to do? The PA or NP should be generating $325 an hour for the clinic by following up with established patients and leave the AWV to the nurse.

Q. We use ________ (enter in the name of the inexpensive EMR you use) and it doesn't give us the printed 5-10 year screening schedule and printed risk factors with medications the way you've described. What options are there?

A. DSA works closely with companies that can give you an easy, inexpensive alternative to document the AWV during the visit. We use programs that allow your nurse to hit print and it prints the report, as well as auto-populates the data into the system. Just give us a call and we'll explain it and see if it's warranted for your clinic. 12 years of teaching the AWV has shown us that the automated methods of doing the AWV results in the practice performing AWVs on more than 85% of their Medicare population. Those still trying to do it manually typically average 21% of their patients. If you want an automated way - schedule a free 15 minute visit with me on a Zoom call at https://my.timetrade.com/book/FRTFQ

ASK US ANY ADDITIONAL QUESTIONS YOU MAY HAVE