Medical practices that still service Medicare recipients rank among the lowest reimbursed for the services they provide. Ironically, these patients tend to be the ones most besieged with chronic illnesses. The good news is that the Affordable Care Act (ACA) now offers significant compensation for their Annual Wellness Visit (AWV) program… if you learn how to leverage your patient population and take advantage of this potential bonanza to your bottom line.

Diagnostic Sales Consultants specializes in revenue-generating and risk management solutions for medical practices. In that capacity we introduce physicians to a turn-key system that helps doctors access tens of thousands of dollars in unrealized annual revenue available to medical practices when they perform AWVs. The average medical practice that services the Medicare population has 1,000 Medicare patient records. This number of patients can add an additional $250,000 to over $1,450,000 annually into your practice, as a direct result of performing AWVs.

Diagnostic Sales Consultants also informs medical practices that the ACA does not require physicians to personally perform AWVs. The physician must merely be on-site when a supervised subordinate, licensed healthcare provider performs the AWV assessment. This is great news to physicians and to medical practices. While you continue to see your patients that really need your personal attention, your medical assistant generates significant additional revenue for your practice by utilizing our streamlined, software-based AWV platform.

Additionally, when providers use our AWV platform it helps them meet Physician Quality Reporting System (PQRS) requirements. In 2015 providers that are not reporting to CMS will be assessed a 2% penalty of eligible reimbursements.

One of the first questions we are often asked is why medical practices need our services when they already have a free AWV questionnaire embedded in their EMR:

1 Compliance: The questionnaire found in the EMR does not provide all of the elements necessary for you to compliantly bill and get reimbursed for an AWV. It does not generate the ACA-mandated Personal Preventive Plan Services (PPPS) report that must be handed to the patient before leaving the office – complete with referrals and action steps for each element of the PPPS, as well as a wellness plan for the next 5-10 years. On the CMS website: “It is thought that the beneficiary would leave the visit with personalized health advice, appropriate referrals, and a written screening schedule, such as a checklist…. CMS does not expect that the health professional would provide only general recommendations during the wellness visit encounters and then mail a personalized prevention plan that incorporates an HRA to the beneficiary outside of the annual wellness visit encounter.” “The result is that each topic in the HRA should be “actionable” in that if the responses identify a risk, the clinician should be able to treat, counsel, or refer the patient, through shared decision making, to an appropriate treatment or risk mitigation program.”

“CMS requires 100 percent compliance on the AWV for reimbursement. Data ‘collection’ on the HRA is only 50 percent of the requirement of the AWV. ‘Action’ on the data is the other 50 percent.” If the protocol is not followed precisely, the physician’s office will not survive an audit, unscathed.

“CMS requires 100 percent compliance on the AWV for reimbursement. Data ‘collection’ on the HRA is only 50 percent of the requirement of the AWV. ‘Action’ on the data is the other 50 percent.” If the protocol is not followed precisely, the physician’s office will not survive an audit, unscathed.

2 Revenue Generation: The questionnaire in the EMR does not automatically generate referrals or identify additional CPT codes that can be billed by your practice as a direct result of the AWV. In a randomized, national sample of physician practices it was discovered that an AWV performed with our HIPAA and CMS-compliant, web-based software generated an average of 11 referrals back into the practice. These internal referrals generated $250 to over $1450+ per AWV patient encounter.

According to ACA the purpose of the AWV is early detection and intervention of medical problems that might otherwise become chronic issues, thereby negatively impacting our healthcare system in the form of astronomical cost for treatment of these chronic conditions. To that end, our AWV system quickly and efficiently facilitates the screening of 55 referrals that can satisfy that ACA goal. In so doing it generates additional CPT codes resulting from our customized AWV screening platform. Our system helps you capture many of those referrals that would otherwise go to other providers, adding even more new revenue, and increasing wellness for your Medicare patients.

Nationwide, less than 6% of physicians are performing AWVs, even though they are mandated by ACA, and therefore, fully reimbursable. This extreme pushback by the physicians is because AWVs are perceived by the physicians as onerous, based upon the complexity of the report required, and the huge amount of time personally required for a physician to perform the AWV.

All Medicare recipients are entitled to an AWV, and Medicare is providing a generous reimbursement. However, without a systematized program in place, the amount of work required makes AWVs unprofitable for most physicians.