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Medicare Annual Wellness Exam. Presented by: Susan Duden, CPC. March 24, 2012. Medicare Preventative Services. Welcome to Medicare exam and physical Vaccines Various Screening procedures Annual Wellness exam. Welcome to Medicare physical.

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medicare annual wellness exam

Medicare Annual Wellness Exam

Presented by:

Susan Duden, CPC.

March 24, 2012

medicare preventative services
Medicare Preventative Services
  • Welcome to Medicare exam and physical
  • Vaccines
  • Various Screening procedures
  • Annual Wellness exam
welcome to medicare physical
Welcome to Medicare physical
  • Must be performed within 12 months of the patient’s effective date of Medicare part B
  • Once in a lifetime procedure
  • Screening EKG is only allowed if referral from the IPPE appointment
  • G0402
  • Flu Vaccine, one per flu season
  • Pneumococcal, 1 per lifetime, unless at risk patient
  • HBV, limited to high risk patients
various screening procedures
Various screening Procedures
  • Prostate blood screening, 1 per year
  • Mammography, 1 per year
  • GYN, every 24 months unless at high risk
  • Colonoscopy, 1 per ten years
  • Bone Mass Measurements, 1 per 24 months
  • Etc.
annual wellness exam
Annual Wellness Exam
  • Allowed 1 per year
  • Cannot be done within a year of the Welcome to Medicare Physical
  • 12 months apart
  • G0438, first visit for wellness exam
  • G0439, subsequent visits, every 12 months
who can perform this exam
Who can perform this exam?
  • Doctor of Medicine or Doctor of Osteopathy
  • Nurse practitioner
  • Physician Assistant
  • Clinical Nurse Specialist
  • Health Professional
    • Health educator, registered dietitian, nutrition professional or a team of medical professionals working under the direct supervision of a Physician
what is included in the annual wellness exam
What is included in the Annual Wellness Exam?
  • This is not a hands on physical!
  • Patient History
  • Benign examination
  • Counseling
establishing the medical family history
Establishing the Medical/Family History
  • Collect and document the following:
    • Past medical and surgical history
    • Allergies
    • Use or exposure to medications and supplements
    • Family history for disease or illness that may be hereditary or place beneficiary at increased risk.
    • A list of providers and suppliers the patient is currently using
review of patient s risk factors
Review of patient’s Risk Factors
  • Screening for depression
  • Screen for risk of falls
  • Questions on home safety
  • Questions on hearing impairments
  • Cognitive abilities
  • The abilities to perform activities for daily living
benign examination
Benign Examination
  • Height
  • Weight
  • Body Mass Index (BMI)
  • Blood pressure
establishing a written screening schedule
Establishing a Written Screening Schedule
  • Make a check list for the next ten years
  • Based on the patient health status and history
  • Include age appropriate preventative services
    • Up to and including bone mass measurements, prostate cancer screening, colonoscopy, mammography, seasonal flu vaccine and pneumococcal vaccine, and, if the patient meets the Medicare guidelines, a hepatitis B vaccine.
establish a list of risk factors
Establish a List of Risk Factors
  • Risk factors or conditions where intervention might be necessary
  • A list of treatment options and their associated risks and benefits
furnishing advise to patient on preventative counseling
Furnishing advise to patient on preventative counseling
  • Personalized health advice with referrals as appropriate
    • Including weight loss, physical activity, smoking cessation, fall prevention nutrition and alcohol abuse
subsequent annual wellness exams
Subsequent Annual Wellness Exams
  • Frequency is 1 per year
  • Updating any of the provider or supplier information, family history, etc
  • Assessing cognitive impairment
  • Weight, BMI, Blood pressure
continued counseling
Continued Counseling
  • Update the written screening schedule developed at the initial wellness exam
  • Update any risk factors that may have been identified
  • Personalized referrals as appropriate.
    • Including lifestyle interventions, weight loss, physical activity, smoking or alcohol cessation, fall prevention and nutrition.
frequently asked questions
Frequently asked questions
  • Is the AWV the same as a yearly physical?
  • Are clinical laboratory tests part of the AWE?
  • Is there a deductible or coinsurance due for the AWE?
  • Can a separate E&M be done on the same day?
what the patient should bring to the annual wellness exam
What the Patient should bring to the Annual Wellness Exam
  • A full list of current providers and suppliers involved in providing care
  • Family Health history with as much detail as possible
  • Medical records, including immunization records
  • A full list of medications
    • Including supplements such as calcium and vitamins
    • How often and how much are they taking
cms links for preventative information
CMS links for Preventative Information