Medicare Wellness Visits for FQHCs - PowerPoint Presentation

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Medicare Wellness Visits for FQHCs

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Medicare Wellness Visit

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Who is eligible for an IPPE or AWV?

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Medicare covers an AWV for all beneficiaries who are no longer within 12 months after the eligibility date for their first Medicare Part B benefit period, and who have not had either an IPPE or an AWV within the past 12 months.

Medicare pays for only one first AWV per beneficiary per lifetime and one subsequent AWV per year thereafter.

Initial Preventative Physical Exam (IPPE): What’s Required?

Health Risk Assessment

Family, Medical, and Surgical History

List of Current Providers

Vitals (Including BMI)

Cognitive Assessment

Depression Screening

Advance Care Planning Services (At the discretion of the Beneficiary)

Functional Ability

Falls Risk

ADLsHearing ImpairmentHome SafetyScreening Schedule for the Next 5-10 years (Recommendations from the USPTF and ACIP)List of Risk FactorsHealth Advice, Referrals, Health Education, Preventative Counseling

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Annual Wellness Visit (AWV)What’s Required?

Review and Update Health Risk Assessment

Update Family, Medical, and Surgical History

Update List of Current Providers

Vitals (Including BMI)

Cognitive Assessment

Depression Screening

Advance Care Planning Services (At the discretion of the Beneficiary)

Functional Ability

Falls Risk

ADLsUpdate the Screening Schedule for the Next 5-10 years (Recommendations from the USPTF and ACIP)Update the list of Risk FactorsHealth Advice, Referrals, Health Education, Preventative Counseling

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Coding for the IPPE and AWV

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Note: Refer to your billing and coding staff at your health centers for appropriate billing processes. Coding practices may differ based on coding and billing workflows. This information is to provide guidance on codes accepted by CMS only.

For more information on FQHC billing, please refer to:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c09.pdf

Billing for the IPPE and AWV

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Coding the Advance Care Planning

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ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a beneficiary to discuss the beneficiary’s wishes and preferences for medical treatment if they are unable to speak or make decisions in the future.

You can provide the ACP at the time of the AWV, at the beneficiary’s discretion.

Not subject to a deductible and co-pay

ONLY

when performed during an Annual Wellness Visit or Initial Preventative Physical Exam

A diagnosis code must be included when billing

AFTER Patient arrives at PHS

BEFORE Patient arrives at PHS

SITE: MA (Assessment)

Start AWV document

Red carpet patient

Falls assessment

Perform TUG Assessment (If needed)

Bring to Room

Check and record vitals

Depression Screen

> 65yo use Geriatric Screen

< 65yo use PHQ9

View All Protocols

Notify Pharm via IM that pt is ready

SITE: CARE TEAM

Re-scrub schedule for flips

Pre-Visit Planning Huddle

SITE: PHARMACY

Begin medication reconciliation

Document allergies

Enter medication refills

Click “Verify Medications” Button

SITE: CM/MA/RN

Acquire Information (CM)

ADL/IADL/Risk Factors

Establish list of current providers

PMH/FH/SH

Advance Directives

Mini Cog

PACE eligibility

Counsel (RN)

Care plan education

Document assessments

CPOE

Order vaccinesIf needed (MA)Administer vaccinesGive iFOBT

SITE: PROVIDERReview assessmentsConfirm f/up planPerform BRIEF face-to-faceProvider signs offPrint Clinic Visit Summary (CVS)Give to pt and walk to next areaORIM MA and MA can give CVS to pt and walk to next area

IF NEEDEDLAB: Bloodwork if appropriate (5 days)PHARMACY: Pick up meds

Visit Complete

PHS Annual Wellness Visit Checklist

CORP: POP MGMT

Identify patients

Distribute reports

SITE: POP MGMT

Pop Mgmt. Calls

Admin pop-ups

Clinical pop-ups

Both w/ end dates

All team members schedule:

As Add-On or RN Slot

Use TTT in provider slot 40 mins later

PCC confirms calls

Reminds patient to bring pill/med bottles

PRE-VISIT PLANNING

Care Management (CM)

Review weekly schedule Friday before AWV

Look for flips

Make schedule

CM distribute schedule to:

Health care Team

RN

Pharmacy

RN PVP

Screenings

Vaccines

Prior AWV

Pharmacy PVP

Assess co-pay;

Visit

Shingles Vaccine

Prints med list

Checks med refills/90 day supply/allergiesAFTER Patient arrives at PHS

SITE: MA (Assessment)Start AWV document Red carpet patientFalls assessment

TUG Assessment if needed

Bring to roomCheck and record vitalsDepression Screen> 65yo use Geriatric Screen< 65yo use PHQ9View All ProtocolsNotify Pharm via IM PHS Annual Wellness Visit Work FlowDay of AWV

BEFORE Patient arrives at PHS SITE: CARE TEAMRe-scrub schedule for flips Pre-Visit Planning HuddleSITE: PHARMACYBegin medication reconciliation

Document allergiesEnter medication refillsClick “Verify Medications” ButtonSITE: CM/MA/RNAcquire Information (CM)ADL/IADL/Risk FactorsEstablish list of current providers (Specialists/DME)PMH/FH/SH

Advance DirectivesMini CogPACE EligibilityCounsel (RN)Care plan educationDocument assessments CPOE Order VaccinesIf needed (MA)Administer vaccinesGive iFOBT

SITE: PROVIDERReview assessments

Confirm f/up plan

Perform

BRIEF

face-to-face

Provider signs off

Print Clinic Visit Summary (CVS)

Give CVS to patient and walk to next area

OR

IM MA and MA can give CVS to pt and walk to next area

IF NEEDED

Patient to Lab:

Bloodwork if appropriate

Remind pt that it takes 5 days for lab results to come back

Patient to Pharmacy

Pick up medications

Day of AWV

Before AWV

Notes:

Visit Complete

Where can I find more information about the IPPE and AWV?

Medicare Learning Network-IPPE and AWV Information

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Medicare AWV: 30-minute webinar

Optimizing Utilization and Implementation of Medicare’s Annual Wellness Visits (AWV)

(control click to follow link)

Medicare AWV Questions

What are the benefits of providing the wellness visits?

What is the difference in the visits?

Who can perform the wellness visits?

If the visit is done at a FQHC does a provider (MD, DO, PA, NP, and CNM)

have to see the patient?

If the AWV provider is a NP or PA will the visit count toward ACO assignment?

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1. IPPE & Annual Wellness

Visits Benefits

Benefits:

No cost to patient!!

Generates revenue for the health center

Supports ACO attribution

Opportunity to address gaps in care

Opportunity to meet GPRO measures (ex., falls assessment)

Could help improve accuracy of HCC coding

Potential additional benefits:

Keep patients healthy

Enhances quality of care

Improves patient engagement

Promote preventive health

Help to build retention

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2. The Initial Preventative Physical Exam IPPE

(“Welcome to Medicare” Preventive Visit)

The patient must receive this service within the first 12 months after the effective date of their Medicare Part B coverage. One-time benefit. Consists of the following:

Review the patient’s medical and social history;

Review potential risk factors for depression and other mood disorders;

Review functional ability and level of safety;

Measurement of height, weight, body mass index (BMI), and visual acuity screening.

End-of-life planning (upon agreement of the individual);

Education, counseling and referral based on the review of previous 5 components; and

Education, counseling and referral for other preventive services, including a brief written plan such as a checklist.

Who can perform an Initial Preventive Physical Exam?

Medicare Part B covers an Initial Preventive Physical Exam if it is furnished by a:

Physician

(doctor of medicine or osteopathic medicine), or

Other qualified non-physician practitioner

(physician assistant, nurse practitioner, or clinical nurse specialist)

2. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1338.pdf

MLN Matters® Number: SE1338 Re-issued

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2. 1st

AWV and Subsequent AWVs

The first AWV includes the following elements:

A health risk assessment;

Establishment of a current list of provider and suppliers;

Review of medical and family history;

Measurement of height, weight, BMI, and blood pressure;

Review of potential risk factors for depression and other mood disorders;

Review of functional ability and level of safety;

Detection of any cognitive impairment the patient may have;

Establishment of a written screening schedule (such as a checklist);

Establishment of a list of risk factors; and

Provision of personalized health advice and referral to appropriate health education or other preventive services.

Subsequent AWVs include the following elements:

Review of updated health risk assessment;

Update of list of current providers and suppliers;

Update medical and family history;

Measurement of weight and blood pressure;

Detection of cognitive impairment the patient may have;

Update of the written screening schedule (such as a checklist);

Update of the list of risk factors; and

Provision of personalized health advice and referral to appropriate health education or other preventive services.

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2. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1338.pdf

MLN Matters® Number: SE1338 Re-issued

3. Who Can Perform the AWV?

Who can perform the Annual Wellness Visit?

Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by the following:

Physician (doctor of medicine or osteopathy)

Physician assistant

Nurse practitioner

Clinical nurse specialist

Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the

direct supervision

of a physician (doctor of medicine or osteopathy).

CMS is not assigning particular tasks or restrictions for specific members of the team. We believe it is better for the

supervising physician to assign specific tasks to qualified team members (as long as they are licensed in the State and working within their state’s scope of practice

). This approach gives the physician and the team the flexibility needed to address the beneficiary’s particular needs on a particular day. It also

empowers the physician to determine whether specific medical professionals who will be working on his or her wellness team

are needed on a particular day.

The physician is able to determine the coordination of various team members during the AWV.

3. Frequently Asked Questions from the March 28, 2012 Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit

https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf

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4. Does a Provider have to see the patient?

At a FQHC, Yes

Billable Visit- Face-to-face encounter between the patient and a Physician, Physician Assistant (PA), Nurse Practitioner (NP), Certified Nurse Midwife (CNM), Visiting Nurse, Clinical Psychologist (CP) or Clinical Social Worker (CSW) during which a FQHC service is rendered.

4. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-PPS-Specific-Payment-Codes.pdf

Specific Payment Codes for the Federally Qualified Health Center December 2016

Prospective Payment System (FQHC PPS)

(Rev. 12-22-16)

Sent:

Tuesday, July 18, 2017 9:29 AM

To:

CMS FQHC-PPS <

FQHC-PPS@cms.hhs.gov

>

Subject:

Medicare Annual Wellness Visit

If a RN performs the annual wellness visit, is it necessary for the practitioner to see the patient to bill for the service (G0438 or G0439)?

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5. Can NPs & PAs perform

the AWV for FQHC patients?

Yes

ACO professional means an individual who is

Medicare

-enrolled and bills for items and services furnished to

Medicare

fee-for-service beneficiaries under a

Medicare

billing number assigned to the

TIN

of an

ACO participant

in accordance with applicable

Medicare

regulations and who is either of the following:

(1) A

physician

legally authorized to practice medicine and surgery by the

State

in which he or she performs such function or action.

(2) A practitioner who is one of the following:

(i) A

physician assistant

(as defined at

§ 410.74(a)(2)

of this chapter).

(ii) A

nurse practitioner

(as defined at § 410.75(b) of this chapter). (iii) A clinical nurse specialist (as defined at § 410.76(b) of this chapter). 19

5. Title 42 - Public Health Chapter IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)Subchapter B - MEDICARE PROGRAM (CONTINUED)Part 425 - MEDICARE SHARED SAVINGS PROGRAMSubpart A - General ProvisionsSection § 425.20 - Definitions. https://www.gpo.gov/fdsys/pkg/CFR-2015-title42-vol3/pdf/CFR-2015-title42-vol3-sec425-20.pdf