Medicare Annual Wellness Exam

1. Medicare Annual Wellness Exam Presented by: Susan Duden, CPC. March 24, 2012

2. Medicare Preventative Services • Welcome to Medicare exam and physical • Vaccines • Various Screening procedures • Annual Wellness exam

3. Welcome to Medicare physical • Must be performed within 12 months of the patient’s effective date of Medicare part B • Once in a lifetime procedure • Screening EKG is only allowed if referral from the IPPE appointment • G0402

4. Vaccines • Flu Vaccine, one per flu season • Pneumococcal, 1 per lifetime, unless at risk patient • HBV, limited to high risk patients

5. Various screening Procedures • Prostate blood screening, 1 per year • Mammography, 1 per year • GYN, every 24 months unless at high risk • Colonoscopy, 1 per ten years • Bone Mass Measurements, 1 per 24 months • Etc.

6. Annual Wellness Exam • Allowed 1 per year • Cannot be done within a year of the Welcome to Medicare Physical • 12 months apart • G0438, first visit for wellness exam • G0439, subsequent visits, every 12 months

7. Who can perform this exam? • Doctor of Medicine or Doctor of Osteopathy • Nurse practitioner • Physician Assistant • Clinical Nurse Specialist • Health Professional • Health educator, registered dietitian, nutrition professional or a team of medical professionals working under the direct supervision of a Physician

8. What is included in the Annual Wellness Exam? • This is not a hands on physical! • Patient History • Benign examination • Counseling

9. Establishing the Medical/Family History • Collect and document the following: • Past medical and surgical history • Allergies • Use or exposure to medications and supplements • Family history for disease or illness that may be hereditary or place beneficiary at increased risk. • A list of providers and suppliers the patient is currently using

10. Review of patient’s Risk Factors • Screening for depression • Screen for risk of falls • Questions on home safety • Questions on hearing impairments • Cognitive abilities • The abilities to perform activities for daily living

11. Benign Examination • Height • Weight • Body Mass Index (BMI) • Blood pressure

12. Establishing a Written Screening Schedule • Make a check list for the next ten years • Based on the patient health status and history • Include age appropriate preventative services • Up to and including bone mass measurements, prostate cancer screening, colonoscopy, mammography, seasonal flu vaccine and pneumococcal vaccine, and, if the patient meets the Medicare guidelines, a hepatitis B vaccine.

13. Establish a List of Risk Factors • Risk factors or conditions where intervention might be necessary • A list of treatment options and their associated risks and benefits

14. Furnishing advise to patient on preventative counseling • Personalized health advice with referrals as appropriate • Including weight loss, physical activity, smoking cessation, fall prevention nutrition and alcohol abuse

15. Subsequent Annual Wellness Exams • Frequency is 1 per year • Updating any of the provider or supplier information, family history, etc • Assessing cognitive impairment • Weight, BMI, Blood pressure

16. Continued Counseling • Update the written screening schedule developed at the initial wellness exam • Update any risk factors that may have been identified • Personalized referrals as appropriate. • Including lifestyle interventions, weight loss, physical activity, smoking or alcohol cessation, fall prevention and nutrition.

17. Frequently asked questions • Is the AWV the same as a yearly physical? • Are clinical laboratory tests part of the AWE? • Is there a deductible or coinsurance due for the AWE? • Can a separate E&M be done on the same day?

18. What the Patient should bring to the Annual Wellness Exam • A full list of current providers and suppliers involved in providing care • Family Health history with as much detail as possible • Medical records, including immunization records • A full list of medications • Including supplements such as calcium and vitamins • How often and how much are they taking

19. Questions?

20. CMS links for Preventative Information • http://www.cms.gov/PrevntionGenInfo/ • https://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf • https://www.cms.gov/MLNProducts/35_PreventiveServices.asp • https://www.cms.gov/MLNProducts/downloads/AWV_Chart_ICN905706.pdf