Proactive Scheduling Can Boost Medicare AWV Appointments

Medicare Annual Wellness Visits (AWVs) represent a big black hole for most practices when it comes to a revenue opportunity. Revenue is lost because practices wait for the patients to request visits.

Patients generally will follow directions and advice from their physicians if the mode of treatment is presented as the standard of care. Conversely, they do not follow through very well on making independent decisions on their care. A care plan delivered to them by a respected healthcare professional -i.e. weight loss programs, mammograms, and prostate screenings. etc. - yield much better compliance.

Patients have shown by the poor record of less than 5 percent participation last year that they are not waking up in the morning and thinking, “I feel good today so I will call my physician and schedule a wellness visit where I have to fill out a long form and spend money on gas to go over and sit there for 45 minutes and get a wellness plan without any treatment for a medical problem.”
AWVs and preventive benefits are the most under- utilized, yet one of the most lucrative, sources of reimbursement for physicians. And, there is no copay for the patient.

AWVs require no diagnosis, no specialized training or staff, no equipment or capital investment and can reimburse 300 percent more than an average encounter.

The outline for success is:
1. Identify Eligible Patients 2. Make Wellness a Standard of Care3. Simplify Data Collection

Here's how to institute these measures at your medical practice and increase participation:

1. Review every patient that is scheduled each week to determine which ones are eligible for either a G0402 -Welcome to Medicare or a G0438 - First Annual Wellness Visit.

2. Alert the provider that is seeing the eligible patient that he/she wants to see them on their next visit and go over important Medicare benefits with no copay and provide them with an annual review of their health risks. Provider interaction is the critical element. Patients are much more likely to accept a wellness appointment if they are told that one is required by their physician or provider. If the suggestion for an appointment is merely left to a front desk person, the patient is not nearly as likely to agree to a wellness visit.

I used the word “required” above although Medicare obviously does not require a wellness visit, but the most successful practices with whom I work have literally made it a part of the standard of care for all their Medicare patients and told them that a wellness visit is “required to provide the recommended level of care by the practice.” If the patient refuses, they are told the practice is not able to provide them with the correct level of care in a firm, but polite manner. Ask them again how to make it more convenient for them to get this benefit. Work with them, don’t just let them reject the idea.

3. Prepare a method of collecting the pre-visit Health Risk Assessment (HRA). These methods include:
A. Hand out an HRA (5 pages to 7 pages) when they leave the office and tell the patient to fill out the forms before their visit.
B. Create an electronic HRA, post it on your patient portal, and give the patient a notice with instructions to take home and log on to complete it.
C. Contact an Internet service that completes an HRA online and direct the patient to go there to complete it, which you will then access to prepare their care plan.
D. Call the eligible patients and tell them a staff member needs about 15 minutes to help them complete a form before their next visit (don’t ask if you “can” complete the HRA). As an example, ask to schedule that call either at 10 a.m. or 2 p.m. the next day. The staff member then either fills in the HRA on paper, an electronic template, or on your patient portal. This creates an extra $200 or more for your practice in about 15 minutes. You can even subcontract that call to current or former staff members from their home. Your medical assistant can make that call since HRAs do not require a physician to complete them. (A person that schedules and completes 10 HRAs from home each week in about five hours at 30 minutes each could generate over $2,000 per week and $100,000 annually for the practice).

I personally recommend to my clients that they collect the HRA info electronically before the visit and create the CMS-required Personal Prevention Plan Services (PPPS) and health risk referral plan in advance. This will allow the practice to complete the AWV in about 15 minutes in the office. Schedule the AWV on the same day as the patient’s next scheduled E&M so the patient’s return visit is combined with a medical service (allowed by CMS with a -25 modifier). That makes it more likely for them to agree to the AWV.

This merely requires scheduling a 30-minute encounter combining a 99213 with the AWV. This also can generate a total of almost $300 for the patient visit that day (versus $70) when the AWV per G0438 and all annual preventive screens are completed (G0442, G0444, and G0328QW).

Use these ideas to schedule at least 200 wellness visits (only four per week) and you will increase your annual revenue by $40,000. You should set a goal of at least 50 percent participation from all your Medicare patients.

Be proactive. Assume the AWV and preventive services are a standard of care and only give the patients a choice of “when” to get the AWV, not “if.” You are the physician. Don’t leave it to the patient to decide their care.

Find out more about Jeff Gatewood and our other Practice Notes bloggers.