Opportunity: Medicare Annual Wellness Visits (AWVs) During a Pandemic

Marcie Ward, Sr. Clinical Consultant Practice Services

The Opportunity

There is no doubt that COVID-19 has upended healthcare as we know it and left healthcare providers and patients in turbulent waters. Our vulnerable populations, already at risk, are taking the brunt of this storm. As we gradually come to terms with the reality that the delivery of healthcare has changed, and may never be the same, it is time to pivot and consider alternatives.

Telehealth visits, once used only in rural areas, are now becoming an “essential service” for the elderly. Considering the risk of venturing to the outside world and the lack of available appointments, telehealth visits ensure that the most vulnerable do not disappear and lose contact with their medical providers. Recognizing the criticality of telehealth medicine during this public health emergency, Centers for Medicare and Medicaid Services (CMS) has made accommodations to expand and ease the delivery of telehealth visits. In addition to evaluation and management visits (routine office visits) and mental health counseling, preventative health screening such as the Medicare Annual Wellness Visit (AWV), can now be completely accomplished through telemedicine.

CMS broadens delivery of the Annual Wellness Visit

With the expansion of benefits under the 1135 waiver by the Centers for Medicare and Medicaid Services, there are exciting changes making the AWV easily accessible to both patients and providers during the duration of the COVID-19 public health emergency.

  • Patients may obtain their AWV from the safety of their home either by video or audio (video component waived if beneficiary does not have access to or chooses not to use).[1,2]
  • Popular platforms may be used such as Facetime, Facebook, Google Hangouts, and Skype without fear of HIPAA non-compliance.
  • Requirements for providers needing licensure in the state where the patient is located has been waived.
  • Vital signs can be self-reported or documented as “unable to obtain due to COVID-19 public health emergency” with the expectation that these will be documented at the next face-to-face visit.
  • Services can be performed by licensed medical professionals or a team of medical professionals* under the supervision of a physician or non-physician practitioner if they are in the same location as the provider and available during the telehealth visit.[2] (* “Team of medical professionals” is a language used by CMS and is admittedly vague. It is recommended to confirm the recommended licenses and medical professionals with your Medicare Administrative Contractor.)

Understanding and making the most of the Medicare AWV during the current public health emergency

Sometimes confused with a yearly physical exam, the Medicare Annual Wellness visit differs in two significant ways. First, it is not, nor does it include, a physical exam.  Second, the AWV is completely covered by Medicare, and although it can be combined with an E&M (Evaluation and Management) visit or yearly physical exam, it is not subject to co-pays, deductibles, and co-insurance. The Medicare Annual Wellness visit is a yearly visit that focuses on prevention. It is a comprehensive visit assessing fall risk, social needs, medication reconciliation, depression screening and dementia screening.

Recent expansion of telemedicine by CMS now offers a broader range of telehealth services and fewer restrictions during the COVID-19 pandemic, making this an opportune moment to focus on your Medicare Annual Wellness Visits. It is possible to complete the AWV in its entirety by telehealth. This is an opportunity not to be missed. These temporary provisions are aimed at helping your practice maintain close contact with your patients while keeping them safe. Simultaneously, you will be able to capture the hierarchical condition category (HCC) codes, close gaps, attain benchmarks, and hold onto your attributed population.  It is important to note that both the Initial Annual Wellness Visit (G0438) and the Subsequent Annual Wellness Visit (G0439) are approved to be delivered via the telehealth modality.[3]

The components of an initial AWV are included in the chart below and can be done at the time of the telehealth visit almost entirely by a team of medical professionals with provider oversight* (*see previous note). Subsequent Annual Wellness Visits are essentially the same, with the goal being to review and update each of the components. To streamline your process, whenever possible send the required paperwork to the patient for completion beforehand. Establish a process to obtain the patient’s consent to perform this visit via telehealth (as this is a CMS requirement).

Communicate effectively and provide “scripts” for your staff to help with anticipated questions

In order to glean the most from the valuable Medicare AWV patient encounter and to establish compliance for subsequent Annual Wellness Visits, it’s important to clear up misconceptions and confusion by explaining to the patient beforehand that the AWV is not the same as an annual physical exam, and that they will not incur a charge. Explain the purpose and importance of the Annual Wellness Visit, and that unlike commercial insurers, Medicare does not cover annual “head to toe” physicals, but only covers E&M (Evaluation and Management) visits – which are problem-based visits that include targeted exams and diagnostic work ups – and AWV visits. If the patient insists on a “head to toe” physical, prepare them for a likely charge associated with this service (although some Medicare Advantage plans do cover annual physical exams). Provide training and scripts for your staff so that they can provide clear explanations and answers to the most frequently asked questions.

Throughout this pandemic, the elderly have been repeatedly identified as our nation’s most vulnerable population. With the temporary CMS provisions lessening the burden, accomplishing the AWV has never been easier, yet many practices are overlooking this opportunity. Prime your practice to ride this wave of pandemic opportunity by partaking in the innovative changes in healthcare recently established by CMS. Begin now by reaching out to each of your Medicare lives, checking in on their health and ensuring their needs are met, while simultaneously developing a robust AWV process that will endure well beyond COVID-19.

To learn more about how to optimize both patient well-being and practice revenue with the current unique CMS Medicare AWV opportunity, reach out to Medical Advantage today.

  1. Editors, F. (2020, May 01). Two welcome changes for audio-only telephone visits. Retrieved September 09, 2020, from https://www.aafp.org/journals/fpm/blogs/inpractice/entry/telephone_visits.html
  2. (2) Centers for Medicare. (n.d.). https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf [Press release]. Retrieved from https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
  3. (3) Salah-Ud-Din, M. (2020, June 10). Maximizing Annual Wellness Visits With Telehealth In COVID-19. Retrieved September 09, 2020, from https://lightbeamhealth.com/maximizing-annual-wellness-visits-with-telehealth-in-covid-19/