Increase Quality Measure Satisfaction through Nurse-led Annual Wellness Visits
by Christina Onolaja, MHA
Primary care providers frequently view Medicare Annual Wellness Visits (AWV) as tedious visits in which patients see little value. With consistent access to care issues and a shortage of primary care providers, these visits are easy to push to the side and focus on other visits. The problem is that these visits can impact attribution and are also a key metric in value-based care plans and Accountable Care Organization (ACO) requirements to receive incentive payments.
So how can a practice balance the need to maintain attribution and satisfy insurance requirements while still providing crucial hands-on care to patients?
The answer may be more simple than hiring more providers or limiting new patients. Nurse-led Annual Wellness Visit programs have been proven to effectively meet the AWV requirements while increasing access to the provider for other visits.
Medicare describes an AWV as a visit centered around the Health Risk Assessment (HRA) questionnaire that is largely hands-off aside from some basic vitals. The HRA covers patient histories, medications, health screening, mental health screening, and Advanced Care Planning.
These visits are also an opportunity to identify social determinants of health, such as transportation issues, behavioral health concerns, or financial constraints impacting the patients’ health. Because the visit is an assessment and documentation, nurses can perform these visits without a provider seeing the patient. Physicians need to sign off on the encounter to bill it under them as the rendering provider, resulting in retained attribution for the patient and satisfied quality measures.
Establish Clear Guidelines
When building a nurse-led AWV program, it is important to establish clear guidelines to include components of the HRA, ensuring the encounter will bill correctly and satisfy Medicare requirements. Most electronic medical records (EMRs) allow templates to be built which will display the fields that need to be completed. Taking the time to build these templates helps nurses maintain consistency in their workflow and streamlines the process. The workflows should clearly define if the nurse is expected to work with the patient to coordinate care, such as specialty referrals, labs, and imaging based on care gaps or chronic conditions.
The initial AWV or Initial Preventive Physical Exam (IPPE) must be conducted by a physician and is billed using code G0438. Subsequent AWVs can be completed by the nurse and are billed out under the provider using code G0439. The current reimbursement rate for G0439 is approximately $117. This visit can only be billed once per year and must be conducted at least 11 calendar months apart to receive reimbursement. Some Medicare Advantage plans have different rules and should be evaluated prior to billing. Additional billing can be submitted for certain assessments, such as a fall risk assessment or PHQ2/9, as well as Advanced Care Planning.
Ultimately, it is up to the practice and providers to determine if this is a program that will benefit the practice and the patients, as well as how to implement it - but the benefits can be significant. Given the shortage, providing a crucial service to patients while satisfying insurance requirements without hiring additional providers is a win-win scenario.
