Maximizing the Annual Wellness Visit

Primary care providers (PCPs), especially those participating in value-based arrangements, have been performing annual wellness visits (AWV) since Medicare started reimbursing for it visit in 2011. The purpose of the AWV is to develop, or update, a personalized prevention plan and perform a health risk assessment (HRA). The AWV is covered once every 12 months after the first year of Medicare coverage, and it has no deductibles, coinsurance or copayments to incentivize the visit to the patient.

While AWVs have proved to be valuable, there are many PCPs who continue to do the bare minimum required for reimbursement. For those providers in value-based arrangements, the AWV can provide an opportunity to move beyond the basics. Below, you will find 3 strategies that your organization can implement to increase your fee-for-service revenue and provide increased value for the patient.

  1. Complete advance care planning (ACP)

The ACP process helps ensure that patients receive medical care that is consistent with their values, goals, and preferences by making these plans available to the treating providers. Those treating providers can then ensure these plans are part of the decision-making process to improve end of life care and reduce end of life costs. There is no co-pay for the patient if the ACP is completed in conjunction with the AWV, and the ACP helps to further strengthen the patient-physician relationship. Multiple studies have demonstrated the value of ACP in helping to reduce end-of-life costs while ensuring that the patient receives optimal care. As for the reimbursement, the first 30 minutes of the face-to-face interaction provides an average of approximately $86.49—and the 99497 can be billed at the same time as the AWV with a modifier. 

  • Review patients’ specialist utilization

The annual wellness visit is an excellent time to review which specialist(s) your patient is utilizing in order to help improve care coordination. The typical experience is as follows: you refer the patient to a specialist for a one-time consultation, however, the patient continues to visit that specialist for ongoing follow up and care.

A few things to consider…

  • Does the patient specifically require these visits?
  • Can these needs be handled in a single location, such as a primary care office?

Alternatively, the patient may be visiting multiple specialists because they are struggling to find a diagnosis, or solution, to their issue—perhaps it’s a good time to revisit care coordination and ensure the patient is obtaining the right care at the right time. When making a referral, remember to utilize high-value specialists—those with great quality, lower costs, and want to embrace value-based care.

  • Accurately capture patient risk through HCC (Hierarchical Condition Category) coding

Hierarchical Condition Category (HCC) Coding aims to predict costs for Medicare beneficiaries based on disease and demographic risk factors. Salient encourages providers to review the accuracy of HCC scores during the AWV for each patient: this is the only way that the Center for Medicare and Medicaid knows how sick your patients. In turn, this will enable CMS to give you credit for the hard work you’re doing, which can significantly impact the ACO’s ability to earn shared savings and avoid shared losses. Reviewing the personalized prevention plan provides the opportunity to address these conditions. Remember to support all coding with documentation using M-E-A-T (Monitor, Evaluate, Assess/Address and Treat).

There are certainly significant benefits to patients, practices, and ACOs for completing effective AWVs, however, ensuring that the ACP is completed, specialist utilization is reviewed, and HCC codes are accurately reflected are just a few examples of strategies that will augment the value of the AWV.

What recommendations do you have to maximize the value of the AWV? We would love to hear your input!

Maria Nikol

About the Author

Senior Business Consultant

Maria Nikol is a Senior Business Consultant with over 12 years of experience in healthcare operations and strategy. She is passionate about the application of emerging policies within the value-based care space. Within her multifaceted position at Salient, she has taken a lead in developing business partnerships. She holds a Master of Jurisprudence in Health Law from Widener University and a Bachelor of Science in Pharmaceutical Marketing and Management from the University of the Sciences in Philadelphia. Her hope is to empower providers with the proper tools and knowledge to efficiently take better care of patients in this ever-evolving industry.

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