Frequently Asked Questions

Do You Have Questions About Annual Wellness Visits?

Learn more about the revenue opportunities, requirements, and benefits of annual wellness visit (AWV) services below.

Who is eligible to provide AWV services?

Physicians of any specialty and non-physician practitioners including:

• Certified clinical nurse specialists

• Nurse practitioners

• Physician assistants

• Medical professionals (including a health educator, a registered dietician, or nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician defined earlier

Who may receive AWV services?

An individual who is no longer within the 12 months after the effective date of his or her first Medicare Part B coverage period and has not received either an intitial preventative physical examination or an annual wellness visit providing a personalized prevention plan within the past 12 months.

What is the reimbursement for AWV services?

Average reimbursement ranges from $170 (inital visit) to $132 (subsequent visits).

What are the key service elements provided?

• Administer and review health risk assessment (HRA)

• Establish a list of current providers and suppliers that regularly provide medical care to the patient

• Establish the paitient's medical/family history

• Review of individual's potential risk factors for depression or other mood disorders using appropriate screening tests recognized by national medical professional organizations

• Review the beneficiary's functional ability and level of safety, including at a minimum:

• Ability to successfully perform ADLs

• Fall risk

• Hearing impairment

• Home safety

• Establish a written screening schedule for the individual such as a checklist for the next 5 to 10 years

• Establish a list of risk factors and conditions for which primary, secondary or tertiary interventions are recommended or are underway for the individual that have been identified through preventative physicial examinations, and a list of treamne toptions with associated risks and benefits

• Furnish personlized health advice to the indidvidual and referrals, as appropriate, to health education or preventative counseling services or programs aimed at reducing identified risk factors

What are the key features of AviTracks-AWV?

• Enables team-based care and care coordination across providers

• Creates electronic health risk assessments and care plans, assigns teams and separates the tasks among physicians, nurses and care coordinators

• Creates custom questionnaires for patient follow up

• Records and logs time for every interaction with the patient

• Assigns a risk level to each patient and adjusts tracking based on the risk profile

• Flags patients by condition, risk or program for easy identification and monitoring

• Can be implemented across multiple care provider teams, letting each group focus on their work while sharing critical information

• Reports statistics by user so that administrators may view staff workload as well as identify highly efficient nurses, coaches and care coordinators

• Creates documentation for billing purposes including CMS CPT codes G0438 and G0439

Which CPT codes are used to report AWV?

There are two CPT codes for AWV. The code you bill will depend on whether you are providing the inital or subsequent annual wellness visit:

•CPT Code G0438 – Annual wellness visit, includes a personalized prevention plan of service (PPS), inital visit.

•CPT Code G0439 – Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit.

Is the AWV the same as a beneficiary's yearly physical?

No. The AWV is not a routine physical checkup that some seniors may get periodically from their physician or other qualified non-physician practitioner. Medicare does not cover routine physical examinations.

Are clinical laboratory tests part of the AWV?

No. The AWV does not include any clinical laboratory tests, but you may make referrals for such tests as part of the AWV, if appropriate.

Can I bill an electrocardiogram (EKG) and the AWV on the same date of service?

Generally, you may provide other medically necessary services on the same date of service as an AWV. The deductible and coinsurance/copayment apply for these other medically necessary services.

How do I know if a beneficiary received their first AWV from another provider prior and to bill for a subsequent AWV despite it being the first AWV provided?

You have different options for accessing AWV eligibility information depending on where you practice. You may access the information through the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) or through the provider call center Interactive Voice Responses (IVRs). CMS suggests providers check with their Medicare Administrative Contractor (MAC) to see what options are available to verify beneficiary eligibility. Contact your MAC for more information.

Do deductibles or coinsurance/copayment apply for the AWV?

No. Medicare waives both the coinsurance or copayment and the Medicare Part B deductible for the AWV.

How does AviTracks-AWV software help with Annual Wellness Visits?

AviTracks-AWV helps automate the AWV workflow - from enrolling the patient, completing the health risk assessment (HRA), to creating a personalized prevention plan and billing for services. With AviTracks-AWV you can customize your workflow, optimize your staff’s efficiency and maximize your AWV reimbursements.

Is there specific technology required to install AviTracks-AWV software?

No, AviTracks-AWV is a cloud-based web application; no new software or hardware installation is required.

What type of security does AviTracks-AWV offer? Is it HIPAA compliant?

AviTracks-AWV is a HIPAA compliant web-based application that runs under encrypted technology, providing security for data in transit and at rest.

Additional security features include:

• Microsoft Azure cloud hosted environment

• Fully redundant data centers in the United States

• Full Chain of Business Associate Agreements

• Comprehensive suite of security technologies

• Antivirus protection

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