00:00:00:00 - 00:00:24:10 Unknown Welcome to Medicare annual wellness visits, utilizing a team based approach for higher quality care. My name is Grayson Kist and I'm a digital communication specialist with Quality Insights. Today's webinar is eligible for Continuing Education credits. To complete the course, the learner must via the webinar and complete the online pre and post test questions and evaluation which will be available during today's presentation. 00:00:24:10 - 00:00:43:21 Unknown Quality insights is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center's Commission on Accreditation. No relevant financial relationships exist for any individuals in a position to control content for this activity. Credit expires on June 27th, 2027. 00:00:44:02 - 00:00:55:06 Unknown After attending this activity. Participants who complete the evaluation will self-report an increase in confidence regarding the topic covered and the ability to apply information to their job. 00:00:55:08 - 00:01:21:07 Unknown After participating in this course, the learner will understand the goals of a Medicare annual wellness visit. Recognize the barriers to completing a Medicare annual Wellness visit. Assess the required components of a Medicare annual wellness visit. Explore the team based approach to Medicare annual wellness visits and identify methods that work best for your individual practice. And review the specialized billing codes and reimbursement for these visits. 00:01:21:07 - 00:01:29:14 Unknown To do your pre knowledge check for this presentation. Use the link or scan the QR code with your phone's camera. 00:01:29:14 - 00:01:54:03 Unknown And now I'd like to introduce our guest today, Doctor Lauren Miller. Doctor Miller was born and raised in Huntington, West Virginia. After obtaining a Bachelor of Science from Marshall University. She attended the West Virginia School of Osteopathic Medicine from 2005 to 2009. After graduation, she completed a family practice residency at Our Lady of Bellefontaine, located in Ashland, Kentucky, in 2012. 00:01:54:05 - 00:02:14:03 Unknown She then accepted an outpatient position from Bellefonte Physician Services and was the lead clinician at her practice site for almost seven years. She also volunteered as medical director, and served as a state certified forensic examiner for a child advocacy center during that same time. In 2018, she accepted a position as Assistant Professor of 00:02:14:03 - 00:02:18:08 Unknown Clinical sciences at the West Virginia School of Osteopathic Medicine. 00:02:18:10 - 00:02:30:19 Unknown She continues to work as a full time associate professor while currently serving as chief Medical Officer for Robert Seabird Clinic. She also maintains a small family practice there and enjoys supervising students and residents. 00:02:30:23 - 00:02:48:19 Unknown She is passionate about patient focused, evidence based medicine with an emphasis on quality assurance and performance improvement. She believes that all treatment plans must always be rooted in empathy and compassion. She is a mother of three in hopes to help them conquer the world. Now I'll turn it over to Doctor Miller. 00:02:48:19 - 00:03:18:15 Unknown All right, so this is me. And after the introduction, I don't think you need to know anything more about me other than, I truly am incredibly passionate about, wellness. And I'll talk about that a little bit more. And, and just to give a, a little shout out, I, I work with a lovely assistant professor, doctor Chelsea Fager SLM, who helped me co-create this, this lecture. 00:03:18:17 - 00:03:52:13 Unknown So same objectives as the one I just read just on my slide deck. So let's get right into it. so types of visits. You've got the Welcome to Medicare preventative visit aka often called the initial and initial preventive preventative physical exam. the first annual wellness visit or the and then the subsequent annual wellness visit. And these are going to be the three we talk about today. 00:03:52:13 - 00:04:17:16 Unknown And what I hope you'll find at the end is that there is not much difference between perform ING these and, the more you can make it homogenized within your office, the more you'll be able to, make it go more streamlined and and help staff pick this up much more quickly. So back to why. Why am I passionate about preventative care? 00:04:17:18 - 00:04:55:22 Unknown So what I love about preventative care visits, it's that it puts everyone on an even playing field. So I work in a small rural health center. and we we can't compete with what is offered at the large tertiary care centers that are, 100 to 200 miles away, depending on which one you go to. And so it is not uncommon for my patients to have to, drive a 100 miles, 150, sometimes 300 miles, just to get to these advanced specialty cares or even just a basic specialist. 00:04:56:00 - 00:05:21:13 Unknown And so what I love is, is that preventative care tries to either prevent the disease from ever coming. So I don't need that tertiary care center or if I can get to it quickly, I don't need the level of specialty. often times if we get to the beginnings of a condition and we're able to treat it, then then, those services aren't needed. 00:05:21:13 - 00:05:52:08 Unknown So the Medicare annual illnesses that are performed at some of the top hospital outpatient services for the top hospitals in the country are the same ones that we can perform in the most rural of places. it allows a provider to get in front of an illness. So one of the things I do in my job is I sit on the admissions committee, for our medical school, and I see all these bright eyed students who come in just passionate about wanting to truly take care of patients and make a difference. 00:05:52:08 - 00:06:22:17 Unknown And, as much as some providers will say to me that this feels like I'm checking a box, you can utilize these, exams to really empower your patient, get in front of illnesses, ward off these horrible side effects that can come with a lot of the chronic conditions that plague my Appalachian area. And, so then when you, I don't know, snuff out that fire before and it even starts. 00:06:22:18 - 00:06:43:11 Unknown What a what a wonderful feeling that you have that you were able to create a difference. And then, more importantly, that you are able to help that patient's life, catching a condition again before it's out of control. Right. More, rewarding career and allows your patients a time to form a close connection with your support staff. 00:06:43:17 - 00:07:06:18 Unknown So what you're going to find as we talk about this is very little of these visits are performed by a physician. So, 100%, your physician needs to be, over citing every every screening that is done. They need to review it. But the actual time performing that visit is generally done with various support staff. And we'll get into this. 00:07:06:18 - 00:07:36:05 Unknown And so why this is so vital is oftentimes when patients have a connection with your other support staff, then they'll ask that question that they may say, I just need to talk to Doctor Miller. So it actually creates just a better culture in general of trust because they get a bigger chunk of their time with my nursing staff, with patient navigators, than what they usually do at any other visit. 00:07:36:07 - 00:08:12:18 Unknown So the other is studies are starting to show that these visits work. So they were initially implemented in 2011. So right as I was in my final year of residency is when these came about, Medicare patients who receive adult wellness visits, at least per the study I list at the bottom, experience a 5.7 reduction in adjusted total health care cost over the ensuing 11 months after these exams are, completed. 00:08:12:23 - 00:08:40:17 Unknown What is really interesting about, what Doctor Beckman and his colleagues found when they did this article was that those who had the highest hierarchal condition category, risk quartile, so those who were deemed to be the sickest were the ones that these visits were helping most, adult wellness visits were not associated with Ed, increased Ed visits or hospitalizations. 00:08:40:19 - 00:09:11:13 Unknown Beneficiaries who had an adult wellness visit were far more likely to receive recommended preventative care. And you'll see why that is incredibly obvious as we get through this, because the entire visit is about what, preventative care services are earmarked for that specific person. So although some are going to be screened for everybody, certain services are going to fit specifically in the demographic for your patient. 00:09:11:15 - 00:09:47:01 Unknown So what are the goals of, Medicare annual wellness. So the truly the intent is to provide older and disabled patients with preventive health measures to help, to help catch or stop progression for many health related or age related conditions. most so for providers, most patient visits are focused on chronic diseases, acute care needs where the Medicare annual wellness visits change focus to assess the whole patient and create a plan to prevent future ailments. 00:09:47:03 - 00:10:16:00 Unknown So that there's three there's three types of preventative care. So you have primary preventive prevention, secondary prevention and tertiary prevention. And the goal of the Medicare annual wellness is to encompass all of these aspects. So when we can you want primary prevention. So preventing a disease of a problem in the first place such as getting to this often is starts with public health initiatives. 00:10:16:02 - 00:10:46:20 Unknown so working on getting exercise and decrease and caloric intake to avoid ever becoming obese. And the conditions for which can come with that secondary prevention really looks at preventing progression of the disease. So maybe you ended up with diabetes or pre-diabetes and you're establishing an appropriate diet, to control blood sugar. In addition, with medication, you're giving education on foot care to prevent diabetic foot ulcers. 00:10:46:21 - 00:11:10:08 Unknown We we miss the mark. We didn't we didn't prevent. And we're not going to, every diabetes case or pre-diabetes case. But if we do diagnose that, maybe we can prevent further complications. And then tertiary, prevention is softening the impact of the disease. And there's sort of a bit of a Venn diagram between secondary prevention and tertiary prevention. 00:11:10:08 - 00:11:33:06 Unknown So the way to think of it is and secondary prevention, they have the disease. And we want to prevent the foot ulcer where tertiary is. They have the disease. They've gotten the foot ulcer and the example I use in the slide they've gotten diabetic retinopathy. But yet we get to it much faster before that condition goes out of control. 00:11:33:08 - 00:12:00:03 Unknown And so it's sort of your last line of at least we got to the retinopathy before it was so severe that the patient was not going to, have, great outcomes to their treatment. So what is, what a Medicare wellness is not it's not a time to create, current illnesses or injuries. This is, preventative care. 00:12:00:03 - 00:12:22:16 Unknown Visit. Now, sometimes I'll address small complaints if we if we see a mole that needs referred, for or to to be taken off, or I need to take it off the following week. but in general, it's not your time for a patient to bring a list of things that, they want to have done that day. 00:12:22:22 - 00:12:54:17 Unknown And it's not a standard physicals. So it's why you'll see me use the term, welcome to Medicare. Visit, Medicare, annual wellness visit, unless that, term initial preventive physical exam. Because when at least how I've always thought of a physical exam. It involves a stethoscope. It involves someone, listening to your heart and lungs. I often have patients that associate it with sort of a sports physical or maybe a genital exam. 00:12:54:17 - 00:13:19:19 Unknown So they've always thought of their wellness visit as getting a pap and nothing else. And so it is not that standard physical. It's really trying to take time and look at what sort of counts as components of physicals. But it's really trying to do screenings mental many status, examinations. But it's not what we think of as getting out your stethoscope. 00:13:19:21 - 00:13:43:00 Unknown I hope it is not a waste of your facility's time. I hope that at the end of this today, I present to you a workflow where you and your patients have a really worthwhile experience. So again, let's go back to the three types of the Medicare annual wellness A, so that we understand which one we need to do on our patients. 00:13:43:01 - 00:14:10:23 Unknown So oftentimes this is where having staff look ahead. maybe someone has flagged a Medicare patient in need of a wellness and visit. And you need to decide what type of visit are you taking the doctor up for? Because we certainly, don't want our docs that the moment that they get, they're trying to figure out, is this a Welcome to Medicare visit, which is in the first 12 months of enrolling into Medicare? 00:14:11:01 - 00:14:39:14 Unknown Is this the initial annual wellness visit where this patient's never had it before, but they're outside that 12 initial, window? Or is there this an annual wellness that is subsequent. So that means, someone whether it's been in your facility or somewhere else, has conducted either the welcome, the initial and now we're time to, to do a, subsequent visit. 00:14:39:15 - 00:15:12:15 Unknown This occurs every year following the initial wellness visit. So oftentimes you think it would go in a three year period. You're welcome to Medicare. Then the next is your initial annual wellness visit, the third year being the annual wellness visits, subsequent and all visits thereafter. There's not much difference between them. You're welcome to Medicare. Visit requires some form of eye exam or eye screening, and an EKG must be offered, but does not have to be done. 00:15:12:21 - 00:15:38:10 Unknown So it's important to make sure that your patients understand that this is a chance to have a baseline EKG that is saved in your chart. Certainly, we want to catch if there's any abnormalities. Again, we're trying to do secondary prevention where if there is an abnormality that we get get in front of this condition and get them to someone before they're symptomatic. 00:15:38:12 - 00:16:08:03 Unknown however, if that EKG is abnormal, then, further workup will be required and that will be outside the scope of the preventative visit, which means that will be subject to copays and deductibles. They're not going to get a referral to a cardiologist for free. And so we just like to make our patients aware of this, because oftentimes we do tell them that the the actual visit is without copays, and they should see no out-of-pocket cost. 00:16:08:05 - 00:16:31:11 Unknown hearing screens can be offered if screens are positive, for hearing loss. So simply asking a patient if they have hearing loss and if they say yes, performing the hearing screen, we actually do an eye exam and hearing screen. It's just a part of our visit on on everyone so that even before they may have noticed they have hearing loss. 00:16:31:16 - 00:16:59:20 Unknown We have a baseline that's in their chart. So what can be done but is not required. So a lot of physicians will use this exam to close their hierarchal care gaps, that have not been, coded in the prior year. So they'll just list the conditions for which have not have not been looked at and, and make a note on their stability. 00:16:59:20 - 00:17:37:17 Unknown And, you know, when they're going to come in for a follow up on that condition. This is outside the scope of today's lecture. But I just if you have, providers who do this or you're doing this in your office, it is it is kosher to do it is not mandated. So oftentimes barriers to visit is the time it takes to prep for a Medicare annual wellness, pending on how many screens a patient has positive or how old a patient is, they might have a lot of, preventative, testing that they are due for. 00:17:37:17 - 00:18:18:14 Unknown And we like to try to prep ahead and make sure. Have you gotten your your mammogram? Have you had your colonoscopy? Do we have it in a chart so that we're sort of teed up and ready, for when they come in the time it takes to complete a Medicare annual wellness. So if one person did it, one person did and everything, and you included prep time, you're probably looking at about an hour, a really efficient and I'm doing more that initial, that first one, maybe, an office that's in a bigger facility that has, a lot of that already, in their EHR. 00:18:18:14 - 00:18:42:00 Unknown So you share any H.R. With who's doing your colonoscopy, is you share any H.R. with the endocrinologist who may be getting those A1 C's? those can sometimes be done significantly faster. and then once you've done one exam and you've collected all that information, then you can usually get that down to 30 or 40 minutes as well. 00:18:42:00 - 00:19:10:01 Unknown Again, I'm including everything from that pre huddle pre visit planning any pre charting all the way up until they leave the office. And so barriers to the Medicare wellness visit is having the support staff that can really take the burden off the provider again. I can't say this enough. There's very little of this, that actually requires a physician to physically perform it. 00:19:10:07 - 00:19:35:09 Unknown So having a support staff to do it is essential if we're going to have everyone working to the highest level of their license and being able to incorporate them into your office, where you feel fulfilled. and then just simple not understanding how to complete all the requirements of the visit. So these these were this came around when I was, a resident. 00:19:35:09 - 00:20:01:07 Unknown We they're not currently taught in exactly this way within our current curriculum. I actually am working on doing a little workshop for the future for students. So when they go off on their rotations, they sort of know what these visits and other types of wellness are. And so oftentimes in an it's completely all right that you don't know, how to do this. 00:20:01:09 - 00:20:24:01 Unknown So let's get to it. What are the components. So components of that welcome to Medicare. And you're going to see overlap. And where there's overlap I'm not going to repeat it again. This is your chance once a year to collect what should have been collected when you first met the patient. But to make sure it's up to date that it's accurate, which decreases, risk of medical mistakes. 00:20:24:01 - 00:20:54:05 Unknown So getting that past medical history, surgical history, hospital stays, operations confirm we've got the allergy list right. Injuries and treatments. So sure once a year bite of the apple to really make sure that you have gotten what maybe that patient establish care in your office ten years ago. You're really making sure that no one's dropped the ball and you have everything up to date, current medications and supplements, making sure those med reconciliations are done. 00:20:54:07 - 00:21:22:18 Unknown Anyone studies, mistakes that are made in the outpatient world? not having updated, medication lists can often be one of them, leading to duplicate medications. family history, reviewing patient's family history, medical events. I especially like to ask anyone in the family with a history of colon cancer, breast cancer, prostate cancer, those ones that we're going to be screening for. 00:21:22:18 - 00:21:43:07 Unknown And I want to know if I've got an increased risk that maybe we've never collected before. And again, it's not me. It's my it's my nursing staff that's asking all of this. I, I assist in doing the training for them to be able to do it. We're going to ask about diet, physical activities, alcohol, tobacco, illegal drug use. 00:21:43:09 - 00:22:11:20 Unknown we're going to review a patient's potential risk factors for depression, past experiences with depression. We use two and nine. I've provided you a link so that you'll be able to, see what what ones might be better utilized in your office. And so they're built into our EHR. full disclosure, we use Athena. I've used epic before. 00:22:11:22 - 00:22:38:17 Unknown that tends to do a little bit better at helping synthesize a little bit of information and not making redundancy. But we have these screenings built in to part of our intake for our nursing staff. So as they're going through, they're just opening up, completing them, marking if they're positive or not. So, reviewing a patient's functional ability and safety level. 00:22:38:23 - 00:23:08:18 Unknown So via direct observation, appropriate screening questions. This is where we're looking at. Are they still able to perform their activities of daily living. Their instrumental task of of living. Are they a fall risk. again we talked about hearing impairment. Is their is their home safe. And again these can be set up in a way where it's really easy for your staff to ask, able to bathe with limited or no assistance. 00:23:08:20 - 00:23:36:06 Unknown And so this is what we use. and they just click through these questions. And so what we sometimes see is someone's had worsening osteoarthritis. Their, their where they were last year isn't where they are this year. And you can kind of jump in and start medicating things. So we use the study fall risk, for ours to do fall risk. 00:23:36:08 - 00:24:05:20 Unknown this is our functional ability screening for hearing. this is our home safety. You don't have to do every single one of these questions. Medicare just not gives specific. These are the ones you have to do. These are the ones that were built into our our our. And so there is some discretion that's sometimes used if we have a patient who's, who's that it's very clearly may be asking of them if they're practicing safe sex. 00:24:05:22 - 00:24:29:08 Unknown doesn't seem appropriate. You don't have to. It should fit the dialog of the conversation. forest management, we use a study. You can also do just a simple. Have you fallen in the last year? Are you dizzy? So, now to the exam. So the exam is going to be height and weight so that you can calculate BMI. 00:24:29:08 - 00:24:54:02 Unknown There's, there's one of your first screens is looking for do I need to do any intervention on if they're overweight or obese. Morbidly obese and blood pressure. Then the visual acuity screen is considered part of an exam. And then this can be where you also do exams that you deem appropriate based on medical, social history, current medical history. 00:24:54:02 - 00:25:20:19 Unknown So oftentimes we will do diabetic for a feed exam. For exam as part of this visit. So our, our ice screen, if, if it's welcome to Medicare, we tend to just perform a corrected and uncorrected, good old fashioned eye chart. but you can also just ask, is there vision problems? If there are, when was the date of your last eye exam? 00:25:21:01 - 00:25:51:01 Unknown And if somebody is having vision problems and they have not seen an eye doctor in a while, this is where you offer to put in that referral. Get them set up to to have a good eye exam. This is also a place to really start discussing end of life planning. and so we have a whole packet of information that, is put together ahead of time that contains West Virginia's, living will medical power of attorney. 00:25:51:03 - 00:26:15:10 Unknown we give steps on how we can help you get it, upload it to the state site. We also provide a card for a notary in our office and someone who, if you want to call back and go over it in more detail, but all this is prepared ahead of time. And then once we have it in their chart, that's a part of that pre visit planning is just making sure that we know that it's there. 00:26:15:12 - 00:26:42:15 Unknown each year. A new component that has been added or relatively new is even if you're not the provider who provides, an opiate screening for opioid, disorder, this is really meant for patients who are currently on opioid prescriptions. So just evaluate is this working for them? Do we have them at a specialist that is appropriate? 00:26:42:15 - 00:27:06:15 Unknown Do we need to set them up for a visit in the next few weeks to go over? specialist. And so this just is a chance that, you know, sometimes on family medicine or primary care will say all this is being taken care of by their pain management specialists, and it's just a chance for you to check in on your patient because these are such high risk medications. 00:27:06:17 - 00:27:43:02 Unknown And then, this is another one that goes with that component, which is screening for potential substance use disorders. So, there's this is not required to have a screening tool in place. I gave you a link where you can find some. So if you have a patient, who test positive for things, this is where we want to see Education Council planning and referral based upon all those screenings that we were doing before. 00:27:43:04 - 00:28:19:13 Unknown So, a part of this is just a brief written plan, like a checklist, so that you can say, all right, we, we're going to screen for diabetes, or maybe you screened within the office, maybe you have an agency machine, or you did a fasting glucose and they screened positive for insulin resistance. So we often have prepared ahead of time a whole stack of different, they're called care instructions and our but information and education so that when they're positive it's already printed out we click that we gave it to them. 00:28:19:15 - 00:28:47:00 Unknown And it's the high chance for my nursing staff to just sort of go over a few things. You can really overwhelm a patient. So sometimes there's a lot I'll I'll give them several, but I'll highlight for them or my nurse will highlight for them what we think is what we really want to focus on. and then also a chance if they screen positive for things, you don't have to address the actual treatment plan that day. 00:28:47:02 - 00:29:07:07 Unknown as long as they don't screen positive for being suicidal or something that's at risk for immediate, you know, high morbidity, high mortality, go ahead and get them set up for, short term follow up with you to address some of these that they've screened positive for. 00:29:07:09 - 00:29:37:04 Unknown And so the annual wellness visit is is very similar to what is in the Medicare annual wellness visit. Except you do not do the visual screening. We still ask if you've had an eye exam, but we don't do any type of vision testing. And then Medicare will not pay for the EKG. What is added as an addition is what's called a, health risk assessment. 00:29:37:04 - 00:30:04:08 Unknown And we actually do these not mandated to at our Medicare annual wellness. Just so they're used to leaving with what a health risk assessment is. And then you're also supposed to do a quick assess of cognitive function. And we do them at both as well. And so you can see these four screenings are done very quickly and very efficiently by our nursing staff at both. 00:30:04:10 - 00:30:34:14 Unknown So the health risk assessment this is where you're collecting all the screenings that we've just done. And they're leaving with some form of written education on their health statuses. whether they're at increased risk of depression, what's their nutrition status? What do we recommend for their home safety? What it's it's sort of a list of of all our thoughts today. 00:30:34:14 - 00:30:56:19 Unknown So back up for a second. Here is an example of what are health risk assessment is. And again most of our nursing staff will have this completed prior to me even walking in the room. So if they don't have an advanced directives on file, we discussed and advised, we have a social worker who will help fill out the forms. 00:30:56:19 - 00:31:23:10 Unknown And so that's one of our drop downs. If they're overweight, what were our recommendations for that house? Their nutrition status, has their physical activity. Are they at risk for depression dementia? hearing care. Vision care. Do we deem if they're independent or if we need to, to mitigate and and change circumstances? Or did we make sure that they already have everything in place? 00:31:23:12 - 00:31:45:14 Unknown are they a far risk? What's our recommendations to prevent falls? what do we deem as safe unsafe about their stairs? Maybe they told you that they have rickety stairs that don't have railings. We certainly can't pay for them to get railings in. But talking with a patient, maybe they've been brought in by the family as to what might be able to be done. 00:31:45:14 - 00:32:11:09 Unknown I will tell you, I'm blessed with a social worker who oftentimes will tell us if there's any organizations in the area that are that are doing anything where we've even had, patients referred to churches that had rails put in. this is also where we look at, their vaccines. And so what are we recommending that they can, do that. 00:32:11:09 - 00:32:40:18 Unknown We did we give them today. are they already in the chart or are we trying to pull in records if they're female? have we do they need, bone density screening if they fit whatever guideline do they need? cervical cancer, HPV, PPV testing. Do we deem that they need, to have, a pelvic exam, breast exam? 00:32:40:20 - 00:33:13:18 Unknown And then when was their last mammogram? And then this, this one is pulled from a, assigned female at birth chart. but if they're if they're male, we have PSA. And then if they are someone who was assigned male at birth, but they've been on estrogen for the past 20 years and they have breasts. sometimes, unfortunately, we don't have a lot of built in templates in our right now for our transgendered population, but we just pull it in. 00:33:13:20 - 00:33:37:20 Unknown Right? It's the difference of pulling in. Did my patient, who still has a prostate but also needs a mammogram. and so and we just try to kind of combine the two. Have they had colonoscopy or any form of colorectal cancer screening? have we screened them for diabetes? when was this goes with that eye exam? 00:33:37:20 - 00:34:07:07 Unknown Have they had glaucoma screenings? Do they qualify for lung cancer screenings? have they had their once in a lifetime hepatitis C screening, or did they need to be screened for. And so that, that is that is that specific to our patients. This gets printed out as part of their after visit summary. And it just allows them to sort of go back and review over everything that, that has been discussed that day. 00:34:07:12 - 00:34:38:14 Unknown So brand new like hot off the presses just was passed. And as of January 1st is we can now, bill, if we are so, if we screen for social determinants of health risk assessment. And so, we're looking at living environment, which ours was already built in access to food is the only one we've realized we need to, update their employment status, education and literacy levels. 00:34:38:14 - 00:34:58:23 Unknown We get that when we to our many colleagues. But, and then family circumstances. And so if you were doing these types of screens, there is now a code for you to be reimbursed for it. So that leads into, the part that most people did not get into health care to become an expert at, which is billing codes. 00:34:59:04 - 00:35:39:13 Unknown So each of those three, have a billing code, specific to them. If you're a federally qualified health center, there is a separate billing code for you. I'm not going to get hugely into these. however, hopefully these slides can be made available to you if you need. if you really want to see and detail all of the different CPT codes for if you do the advanced care planning and what has to be done to bill that your depression screen counseling on preventing tobacco use, alcohol use, screening and counseling, intervention for obesity. 00:35:39:13 - 00:36:05:14 Unknown And then there's the new one, which is the social determinants of health. One thing to remember these can be done over multiple days. One of my absolute favorite thing to incorporate into an office setting is where we call the patient the day before, confirm that they're coming and ask some of our screening questions. Maybe they're due for a flu shot, and we ask if they're going to want that today. 00:36:05:16 - 00:36:23:18 Unknown And so anything that is done in the few days before can actually be, as long as they're addressed, right, that they declined the flu, vaccine or that they accepted it at that visit. 00:36:23:20 - 00:36:53:17 Unknown And then, this is just an idea of reimbursement rates. and so I did. And so what I will say to this is you truly want to know what your fee rate is in the area. contact your billing office, or if you get here on the CMS, dot gov Medicare physician fee schedule, you put in your literally your zip code and it helps understand what you're going to get back. 00:36:53:22 - 00:37:33:03 Unknown This is really just a general idea of the reimbursement for these. And so if you are and so I'm going to get to the part of this can be very financially, beneficial because if you are not and fxxk are in RHC, you can perform a Medicare annual wellness on the same day that you were that you were seeing a, follow up for their chronic care conditions, or you're seeing them for toe pain and, your nurse goes ahead of time and gets and gets their subsequent visit. 00:37:33:05 - 00:38:08:17 Unknown And so they can be billed together, both visits. As long as you show that you've separately done a good note for that toe pain or that follow up on hypertension, and you have your note for your Medicare annual wellness. And so then you can put a modifier and get an additional 166, $130 for the visit. What also makes these more financially lucrative is I just put, the average for the advanced care planning, but oftentimes these are coded with multiple things. 00:38:08:19 - 00:38:49:20 Unknown And so, it tends to get up to the reimbursement closer to one in BCC. we'll get, which is roughly around $320, 280 depending on it. and that's because RHC and FCS get flat rates, where if you work for a facility that's outside of those, you, you just compile all the things you've done. And again, if you work outside of an RHC, in fact, in addition to maybe what you charge for that 9921 3 or 9 921 for that day. 00:38:49:21 - 00:39:17:05 Unknown So this is one of my favorite things to discuss about which is there literally not enough hours in the day. So it's one of my favorite studies that's come out. And the last decade. So there was research conducted through the University of Chicago, Johns Hopkins University, Imperial College of London that looked at how many hours in a day does primary care physician need to accomplish everything that we're asking of them? 00:39:17:05 - 00:40:03:01 Unknown If they truly do, all their evidence based medicine, following all guidelines for all things. And so they said that a physician would need to work 26.7 hours in a day to be able to accomplish everything. And so and this is with just a standard patient panel. And so they took it a little bit farther and they said, and we'll even tell you how when you create 26.7 hour day, what you're going to be spending your day on, and so you'll be spending 14.7 hours on preventative care, 7.2 hours on chronic disease, 3.2 hours on, acute care, and then 3.2 hours on documentation and inbox management. 00:40:03:03 - 00:40:17:19 Unknown And so, it's not possible. It is not possible. So I use this article a lot to explain why it is so important to utilize a team based approach. 00:40:17:21 - 00:40:39:23 Unknown And so if you use a team based approach, you can get a physician's day down to 9.3 hours. Now they have not figured out how to get us down to an eight hour workday, but this is much more manageable and accomplishable than figuring out how to extend, the day from 24 hours to 26 and never sleeping. 00:40:40:01 - 00:41:04:21 Unknown So how I suggest that you get it all done. It is an all hands on deck scenario where you are looking at your physician's assistance, your CNAs, your medical assistance. I am sorry about the dings. your licensed practical nurses, your social workers, diabetic educators, patient navigators, care coordinators, and having them do the majority of this work. 00:41:04:23 - 00:41:40:18 Unknown So if it is done correctly for for my office, I am in the room for no more than five minutes. I come in, I say, it's so good to see you and B I'm glad Obi and Andy are doing wonderful. Well, thank you for agreeing to your mammogram. If there's something that my nurse thinks that they need further discussion with, like she's not sure if she wants a colonoscopy versus a Cola guard, this is my chance to pitch that, but it is really just to review over and sign off on the orders and get the plan started. 00:41:40:19 - 00:42:06:23 Unknown when you utilize this approach, it has been shown to increase both patient buy in and compliance. And what's interesting is, is that oftentimes in surveys, patients complain that they don't have enough time with their doctors, but in practices that have really embraced these, using team based, medical teams, so they're actually spending less time with their doctor, patient satisfaction increases. 00:42:06:23 - 00:42:34:12 Unknown So what really the likelihood is, is patients just want to have time with someone and make sure that they feel that they're well cared for. So this is just a little model that I've came up with on how we like to utilize, our all hands on deck approach. We have, we do education at all levels as well. 00:42:34:17 - 00:43:08:14 Unknown We have our scheduling, having education on these course. Our care coordination actually is the most educated on on these nursing staff, physicians and billing team. And so you can see what each are able to, accomplish. So how do you how do you get staff by. And I think it has to be education. you've got to have everyone on board wanting to, help schedule these appointments. 00:43:08:14 - 00:43:26:23 Unknown I always say if you've had a call and someone has, Doctor Miller wants you to come in for a Medicare annual wellness. And they talk to my receptionist or my patient service representative at church or at the farmer's market, and they say, what's this thing? She asked me to come in for? And they go, I don't have any idea. 00:43:26:23 - 00:43:52:00 Unknown They just started doing it. And I don't even know. They they don't even use their stethoscopes. it'll kill you. So what you have to have instead is, oh, is this really great visit where she has a chance to have her staff and meet with her to go over everything for your preventative care. And so every level really has to have buy in on these appointments. 00:43:52:00 - 00:44:13:15 Unknown And they and and then if your office has never done them before figuring out different ways to try to solicit these, whether it's, handouts in the room, whether it's calls where, they ask to schedule and then explain it a little bit, it really has to be a group effort to get it done. All right. 00:44:13:16 - 00:44:39:02 Unknown So my takeaway today. So again these visits have to be a group effort. Everyone in your practice needs to believe they are beneficial. And see their benefits so that when they're asked about it, they they're able to tell a patient at least a little something on what their benefit is. And really the key is education, not just to your staff but to your patient population. 00:44:39:02 - 00:45:03:11 Unknown Get them shifting from you. Don't just come to the doctor when you have a list of complaints. You come to the doctor when you need to find health. And so this is my list of references. It's got, I think some really great articles that, on this, not just on how to perform annual wellness exams, but also looking at, how they can be of benefit. 00:45:03:13 - 00:45:28:11 Unknown And then I just want to say thank you today. Thank you for giving me the opportunity to speak to you about one of my major passions. And, I'm Doctor Lauren Miller, and I've included my email. I tend to try to get to my email, within a couple of days. And so I would love to talk to anyone who has any questions about these if you'd like to reach out. 00:45:28:13 - 00:45:38:21 Unknown So this is the time where, if you have any questions, you're more than welcome to ask me. 00:45:38:23 - 00:46:01:07 Unknown We do have a few questions already, so I'll start with the first one. How do you know the patient had an annual exam or month? They had it before if it is a new patient in practice. So for for us this is where our care coordination is really beneficial. They actually can look to see if the claim has been submitted. 00:46:01:09 - 00:46:32:22 Unknown and, and what that claim was. And so I do not know exactly to what website they are they are getting under. But that is that is what we do with, our newer patients is and, and sometimes it's also just asking some of them. Absolutely. No. Sometimes it's we and oftentimes to before we do that, if the patient, brings their records and we can look and see if it's been done is another thing that we do as well. 00:46:33:00 - 00:46:40:00 Unknown But there is a way to look it up and, and essentially ask Medicare, has this. 00:46:41:22 - 00:46:48:22 Unknown I think we may have lost Doctor Miller. We'll see if she comes back in in a few moments. 00:46:50:22 - 00:47:14:18 Unknown I do see there's a question. Do we get this recording? We will provide the recording, following the webinar. And, this slides as well. And I also can provide a link in the chat for, checking for annual wellness visit eligibility. there's a couple of different ways. And then when in doubt, you can contact your Medicare administrative contractor. 00:47:14:20 - 00:47:33:03 Unknown That's a way to, to assure that your, your patients are eligible. look, for that Lincoln, put it in the chat in the meantime, and we'll wait a couple moments to see if Doctor Miller is able to get back on. 00:47:33:05 - 00:47:41:16 Unknown I also see that Lisa has her hand up, but we'll just wait a minute and see if we can actually get. Or if we can get Doctor Miller back on. 00:47:43:05 - 00:48:02:03 Unknown I'll take a moment and share in the chat. Also, our annual wellness visit landing page. So this is a page, from Quality Insights that contains a number of links. this is both patient and provider facing education. I think I'm putting it in the wrong chat, so I'll make it. Sure it goes out to everybody. 00:48:02:05 - 00:48:33:00 Unknown it's quality Insights Zorgo WV. And you can find, things that help, practices. But then also, basic education like checklists, and basic annual honest visit education for patients. So the you wellness visit landing page has a couple downloadable resources. And it also has a few YouTube videos. we also had a webinar, I believe it was in 2022 with Doctor Pinson on the annual wellness visits. 00:48:33:00 - 00:48:48:05 Unknown If you're interested in, some more on continuing education opportunity. oh, I see Doctor Miller's internet crashes joining on her phone. Okay. So we'll, hopefully hear back from Doctor Miller and, answer the last few questions. 00:48:49:04 - 00:49:17:01 Unknown While we're waiting, I'll put a link in the chat to, from Medicare, Learning Network. It's checking Medicare eligibility. So there's a few, a few different ways that they have listed. One of them being the Medicare administrative contractor provider portal. billing agencies, if you happen to have if you're from a practice and you have the, the an eligibility services vendor, sometimes that's an available option. 00:49:17:03 - 00:49:32:12 Unknown And then lastly, there's the HIPAA eligibility transaction system, otherwise known as heads. So I'm going to put that in the chat. It's from it's from CMS. So again the learning Medicare Learning Network. 00:49:32:14 - 00:49:46:15 Unknown This is general eligibility not specific to an illness visit. But those are a few ways, that I'm aware of to, to check that. 00:49:46:17 - 00:49:59:23 Unknown Oh, the whole school internet. great. And, you know, we can provide here with, with another link to join from our phone. Yes. I will see if I can send her one. 00:50:00:01 - 00:50:12:11 Unknown All right. Thank you. And worst case scenario, we'll take your questions. back to Doctor Miller, and then, you know, we can follow up with them and make sure to get those answered. 00:50:14:21 - 00:50:21:07 Unknown It looks like she's joined as a panelist. 00:50:21:09 - 00:50:28:12 Unknown I'm trying to get her unmuted. I'm not sure if she's, Doctor Miller, if you need to unmute yourself or not. 00:50:29:12 - 00:50:55:02 Unknown All right. So sorry. I did this at a major medical school thinking that was the most solid internet in our rural area. Can everyone hear me now? Yes, we can hear you. All right. I do not know where I completely cut off. so there's a few minutes left. Can do you want to just give me some questions and I'll do my best. 00:50:55:02 - 00:51:26:22 Unknown And I apologize again. Yes. All right, so we have, a few more questions. If services from the annual wellness visit are recommended, such as Gyn, will your staff also find a provider that will complete the service? Yes. So it may not be completed at the same day. it may be that we schedule them for age. literally a pap smear. 00:51:27:04 - 00:51:48:21 Unknown That or a pelvic exam speculum exam that includes HPV testing or the PAP. And then it's billed as that CPT code. You do not need to sort of do an entire note. You can reference the Medicare annual Wellness. 00:51:48:23 - 00:52:25:01 Unknown All right. And then we have another one codes. Do they work with Medicare Advantage plans. And also do we get this recording. And the second part of that is yes, you will get this recording. So all all whether we are the codes works for Medicare and advantage plans. the certainly the, the three G codes. and so what I will say is, is that all insurance carriers are required to allow you to do the Medicare annual wellness are required to do an annual wellness visit. 00:52:25:03 - 00:52:50:04 Unknown And so, yes, you would use the G codes, for that, I am not 100% on all the CPT codes, but we we the physicians, when we are performing them, they get loaded up and sent to the billing office. So they're submitted. All right. And that's all. If there's any other questions you can put them in there. And then there was also a comment that said thank you. 00:52:50:04 - 00:53:18:19 Unknown Great job presenting. Well, thank thank you guys. so much. And again, so you I think that this only, reiterated that I am in a very rural area. The fact that our, entire, medical school currently has zero internet at the moment. So, this only happens maybe a couple times a year. So, sadly, it happened while we did this. 00:53:18:22 - 00:53:35:09 Unknown As a reminder to receive your free nursing CE credit for participating in this presentation. Complete the online pre and post test questions and evaluation. Once you successfully complete them, you will receive a link to complete and download and or print your Certificate of Participation. 00:53:35:11 - 00:53:43:23 Unknown The evaluation link and QR code are currently on the screen. Thank you everyone for attending this webinar. We hope you can join us again next time.