Improve Care and Increase Revenue with Medicare’s AWV

Are you promoting the new Medicare Annual Wellness Visit (AWV) to your patients? If not, you should be. This annual benefit, available to all Medicare Part B patients, is an opportunity to improve the quality of care you deliver to your patients while creating an ongoing revenue stream.

Created through the Affordable Care Act (ACA) and intended to prevent and/or slow the progression of chronic conditions, the AWV is an excellent chance to enhance the care you deliver to your patients. These visits can be an opportunity to detect undiagnosed diseases, recommend healthy lifestyle changes and encourage patients to get the preventive services they need in the future, all of which ultimately contribute to healthier patients.

In addition to promoting the wellness of your patients, the AWV can provide an excellent source of recurring revenue. According to the American Academy of Family Physicians, the average reimbursement for the initial AWV (G0438) is $166 and the average reimbursement for the subsequent AWV (G0439) is approximately $111. While the AWV represents a significant source of revenue when multiplied by all your Medicare patients, the real opportunities lie in the potential downstream revenue from additional services, screenings, tests or treatments for chronic conditions diagnosed during the AWV. Medicare covers a number of services, screenings, tests and treatments that may be provided during the AWV or another E&M encounter. The average reimbursement for all services that arise from the AWV can total more than double the reimbursement for the AWV visit. According to an article from PhysBizTech, one primary care practice reported an average reimbursement of $375 for all the services that arose from the AWV. Do the math: if you were reimbursed an average of $375 for all of your Medicare Part B patients once a year, how much recurring revenue would that represent? Keep in mind that the AWV can be delivered by non-physician practitioners (NPPs), which makes the AWV even more profitable.

However, providers should be cautioned that the AWV is not simply at billing technique. CMS has launched audits under its Recovery Audit Contractor (RAC) for inappropriate coding and financial recuperation. Providers need to be diligent in making sure they are auditable. This means documentation must be complete and processes consistent. More and more, providers are looking to their health IT vendors for direction on these federal initiatives, making the need to have a true technology partner a cornerstone to success.

You can't afford to miss out on the opportunity to provide these services and your patients can't afford to miss out on this benefit that costs them absolutely nothing out of pocket. You also cannot afford to take a flippant approach to practice redesign using health IT.