Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians
Very few offices and clinics are performing the Medicare annual wellness visits (AWVs) the way CMS designed them to be done.
Some offices try to fit the patient into the doctor's schedule, thinking that the AWV is an annual physical - which it is NOT.
The AWV can be performed solely by a licensed nurse (LVN, LPN, RN) without the physician or NP or PA seeing the patient during the visit - per CMS. It is a RECORD-KEEPING visit - and not a physical and definitely not an annual complete exam that some think it is.
The patient must complete a Health Risk Assessment (you can download one on our Free Documents page) and after that, six services must be completed. You can even watch a 10- minute video we created to help you see exactly what must be completed during an AWV.
One of those requirements is that you must test the patient to determine whether there are COGNITIVE deficiencies or impairments. Many clinics are failing to do so and when they are audited by Medicare, they will be refunding Medicare. There is basically 2 ways to test the cognitive function on patients. We have a page on this website that deals specifically with the Cognitive Testing.
Prior to the patient leaving the AWV, the provider or nurse must hand the patient a PRINTED 5-10 year screening schedule as well as a list of what medications the patient is taking (list of risk factors and treatments). Audits reveal that few offices are meeting this requirement. There are easy ways to accomplish this, depending on the EMR system you utilize in your clinic.
The AWV, if performed as we recommend, is extremely PROFITABLE.
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.
1. Update the HRA
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.
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.
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 show you the profitability of the AWV. Give us a call at 903 871-1172 or email us at email@example.com and let us schedule it for you. Remember - if that call doesn't help you increase your clinic income by at least $20,000 per year - you pay us nothing for that consultation.
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 $202 on average - making the AWV income between $320 and $470 overall. For more information on Cognitive Testing - see our Cognitive Testing Page.
HCPC code G0438 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.
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.
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.
Q. Our doctor always bills an office visit with the AWV, so our income averages around $200 or more. Is this legal?
A. That's a great way to get Medicare to recoup money they've paid you and when the RAC auditors finish, you may find the $5,000 penalty per claim is a higher price to pay than you expected. If your doctor routinely bills a visit with the AWV, I suspect that a high number of those will be a problem when you're audited.
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.