How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam

April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   Preventive Medicine Service   Risk Adjustment   
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Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does not usually trigger the annual deductible. During the COVID-19 Public Health Emergency (PHE), the number of patient encounters has been significantly reduced due to a number of reasons, including: 

  • Unwanted exposure to the virus
  • At-risk providers changing to telemedicine services only
  • Patients who
    • are not tech savvy
    • do not have the equipment (e.g., smart phone, internet connections)
    • do not know how to initiate or log into the telemedicine software program

These issues, and more, have led to a significantly reduced number of patient encounters. This includes  the annual wellness visit, which when properly documented, is a great source of patient information that can be used in risk adjustment coding and reporting. To add insult to injury, it has been reported that beneficiaries who have not completed their annual wellness examination by June of the current year have a greater than 50% chance of not completing one by year end. Without wellness visit data for risk adjusting, the payer could be faced with a reduction in Medicare funding even though the patient may continue requiring a higher level of care. To secure funds sufficient for future care, it is imperative payers work closely with beneficiaries, as well as providers, to: 

  1. Schedule beneficiary annual wellness examinations, either in person or via telemedicine
  2. Provide easy-to-follow telemedicine instructions and a liaison at the provider's office to walk beneficiaries through the set up if need be (even by phone)
  3. Encourage an audio-only annual wellness visit if the patient is incapable of connecting properly or simply does not have access to audiovisual equipment (e.g., smart phone)
  4. Work with the provider to remind beneficiaries that preventive services like the annual wellness exam are a no-cost visit, unless during such a visit the provider feels the need to perform or order tests or treatments that are separately billable from the preventive service itself.

According to the List of Current Telemedicine Services on the CMS website, they continue to identify services eligible not only as a telemedicine service, but even those for which an audio-only connection continues to qualify. Included on this list are:

  1. G0438 Initial annual wellness visit
  2. G0439 Subsequent annual wellness visit

Telemedicine services have quickly become a favorite among Medicare beneficiaries. According to a CDC report, telemedicine services increased among Medicare beneficiaries in 2020 from 14,000 to almost 1.7 million in just the last week of April 2020 alone. While numbers are still high, they have declined somewhat since the initial onset of the PHE. President Trump, seeing the need, signed an executive order in August of 2020 aimed at expanding access to telehealth services beyond the COVID-19 PHE. This will especially help rural America, where accessing healthcare services often poses many challenges not seen elsewhere. Take the time now to work with providers and beneficiaries to schedule and complete an annual wellness for each individual before year’s end.

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