Annual Wellness Visit - Federally Qualified Health CentersCreating a personalized PREVENTION and treatment plan is an essential yet often overlooked health service. The Centers for Medicare and Medicaid Services (CMS) has acknowledged this care gap and has created a series of wellness benefits that emphasize the importance of providing these services annually for every patient. Caravan Health believes these are an optimal opportunity to engage with patients to improve patient experience, outcomes and cost of care.

Utilize Lightbeam, EHR, client portal or MAC to identify patients eligible for Annual Wellness Visit or IPPE.

Call identified patients to explain need and reason for visit.

Explain services, team roles, purpose and benefits of visit prior to proceeding with services.

Verify past medical & family history, all current prescribed and OTC medications, Vaccination & Prevention status, treating providers.

Review appropriate coding and identify any HCC gaps that need to be addressed by provider.

Take time to review and document all ACO and organizational quality metrics in the appropriate location within EHR.

Confirm patient’s readiness for ACP and discuss the patient’s wishes and preferences for medical treatment.

Provider closes visit and/or proceeds to appropriate E&M visit- reviews and interprets screenings, PMHx, HCC, Meds, prevention, & orders necessary services.

Determine need for Chronic Care Management or other care coordination services.

caravanhealth.com

Discuss and perform additional health risk screenings- PHQ-9, Mini-Cog, Timed Up-and-Go, tobacco and other applicable SBIRT screenings.

W O R K F L O W

PatientEligibility

ReachOut

Engage

Verify MedicalHistory

Note ComplexityCoding

Tick theBox

Initiate AdvanceCare Planning (ACP)

OverseeingProvider Visit

Need for OngoingCare Coordination

EvaluateAdditional Risks

What is an Annual Wellness Visit? Coding, Billing &Reimbursement Specifics

Who Can Perform the AnnualWellness Visit?

Medicare covers two separate types of preventive visits. Both services provide a valuable opportunity to establish the foundation for team-based primary care.

Initial Preventive Physical Exam (IPPE)• An introductory visit for new Medicare patients that

can only be provided within the first 12 months the patient receives Part B benefits.

• Includes a physical exam.

Annual Wellness Visits (AWV)• An annual benefit for Medicare patients covered under

Part B.• This visit is covered once every 12 months who have

not gotten either an IPPE or an AWV within the past 12 months.

• Medicare pays for the Initial AWV once per lifetime and pays for one Subsequent AWV per year thereafter visits). An IPPE is not required for an Annual Wellness Visit.

• Does not include a physician exam.

Initial Preventive Physical Examination (IPPE):• Visit is reported with HCPCS code G0468 on TOB 77X. • G0468 must be accompanied by qualifying visit code G0402, with

revenue code 052X.• All components must be provided prior to submitting a claim for the

service. • When IPPE is provided in a FQHC, the professional portion of the

service is billed on TOB 77X.• Use the appropriate site of service revenue code 052X using G0468

and must include HCPCS code G0402.• Medicare will make an additional AIR payment for IPPE, when billed

on the same day with another FQHC qualified encounter/visit.

Annual Wellness Visit (AWV):• Visit is reported with HCPCS code G0468 on TOB 77X• Can be billed as a stand-alone visit under revenue code 052X or 0519

using G0468 and HCPCS codes G0438 (AWV, Initial) or G0439 (AWV, Subsequent).

• G0468 must be accompanied by qualifying visit code G0438 (AWV, initial) or G0439 (AWV, subsequent), with revenue code 052X.

• If it is the only medical service provided on that day by a FQHC practitioner, you must report any pertinent active diagnosis code from the beneficiary’s health history when submitting a claim.

For Both Services:• All components of the visit must be provided prior to submitting a

claim for the service• The beneficiary coinsurance is waived• FQHCs billing under the FQHC PPS will receive an adjustment factor

of 1.3416 to their rate when G0466 (Medical, new patient) and G0468 (IPPE or AWV) are reported together, the add-on payment will be applied to G0468.

Separate same day E/M Services:• If the AWV is furnished on the same day as another medical visit, it is

not reimbursed separately and is included in the All-Inclusive Rate (AIR).

• FQHCs billing under the FQHC PPS will have an adjustment factor of 1.3416 to their rate when G0438 or G0439 are added to claim.

• The beneficiary coinsurance is waived.

Advance Care Planning (ACP):• ACP can be done during the AWV, at the beneficiary’s discretion and

reported with CPT® code 99497, but there is no additional revenue.• FQHCs can bill this as a stand-alone service. • You must report a diagnosis code that is consistent with the beneficia-

ry’s exam when submitting a claim for ACP as a sole service.

Annual Wellness Visit Components– Initial AWV and IPPE

caravanhealth.com

Initial Preventive Physical Exam(IPPE):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nurse specialist).

Annual Wellness Visit (AWV):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nurse specialist); or

• Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner); or a team of such medical professionals who are working under the direct supervision of a physician.

Talk with your Caravan HealthImprovement Manager, Clinical Leaderor visit the Medicare Learning Networkfor more information.1. Perform a Health Risk Assessment (AWV only)

2. Assess Cognitive Function (AWV only)3. Establish a list of current providers and suppliers (AWV only)4. Complete review of beneficiary & medical history 5. Measure height, weight, blood pressure, BMI, and (pertinent physical & visual acuity for IPPE only)6. Review the beneficiary & potential risk for factors for depression, including current or past history

of depression or other mood disorders with appropriate screening tool7. Review the beneficiary & functional ability and level of safety (ADLs, Fall Risk, Hearing Impairment, Home Safety) 8. Establish an appropriate written screening schedule for the beneficiary such as a checklist for the next 5-10 years 9. Establish a list of beneficiary risk factors and condition for which primary,

secondary, or tertiary interventions are recommended or underway 10. Provide the beneficiary with personalized health advice providing appropriate

referrals for health education, counseling or other necessary services.11. Furnish, at the beneficiary’s discretion, advance care planning services (ACP)