The term "an ounce of prevention" takes on new meaning in the era of value-based reimbursement and the Medicare Access and CHIP Authorization Act (MACRA), with their focus on wellness and preventive care.
In this new environment, providers and clinicians are charged with improving quality and reducing costs, says Daniel Bluestein, MD, CMD, a family medicine and geriatric physician.
He's also professor and director of the geriatrics division in the Department of Family & Community Medicine, Eastern Virginia Medical School, and practices independently in both Norfolk and Portsmouth, Virginia.
Bluestein is an expert on the revenue potential from the Medicare Annual Wellness Visit (AWV), added as a benefit of the Affordable Care Act in 2011. Here's what he says you should know to maximize this specific visit for your patient and for your practice.
1. It's different from and better than a 'regular' physical.
This is an opportunity to really coordinate care, he says. It's a time to talk proactively about the "whole" patient, especially their medical and family history and current health conditions, along with medications and supplements. The provider can also obtain specific vitals, such as height, weight, body mass index, blood pressure and vision, and discuss recommended screenings and vaccinations.
"If necessary, providers can still add a significant, separately identifiable evaluation and management (E/M) service code from the same physician on the same day of the procedure or other service if applicable," Bluestein says. "For example, if the patient brings up an ‘Oh, by the way, doctor’ topic that's then discussed during the AWV, use the 25-modifier."
The wellness visit is also a golden opportunity to discuss the extremely important topic of advanced care planning and for referrals to community-based health resources if applicable.