Get ready for annual visits for your Medicare Advantage patients

Now that we’re embarking on a new year, you’ll start seeing new and existing Medicare Advantage patients for their “welcome to Medicare” visits, annual wellness visits or routine physical exams. To help you prepare, we want to share this important information about these different visits:

• New Medicare Advantage members should be scheduling their “welcome to Medicare” preventive visit, also known as the initial preventive examination, and their routine physical exams.
• Existing Medicare Advantage members should begin scheduling their annual wellness visit and their routine physical exams.

Welcome to Medicare visit
The “welcome to Medicare” preventive visit is sometimes referred to as the initial preventive examination. This is a one-time appointment for new Medicare patients to be scheduled within their first 12 months of enrollment. Medicare pays for one “welcome to Medicare” visit per member, per lifetime.

This visit is a great way to get up-to-date information on health screenings, shot records, family medical history and other preventive care services for your patients. These visits can be scheduled at the same time or coordinated with the patient’s routine physical exam to get the best picture of your patient’s health.

The “welcome to Medicare” visit will include a health risk assessment and self-reported information from your patient to be completed before or during the visit. For more information about health risk assessments, visit Framework for Patient-Centered Health Risk Assessments on the Centers for Disease Control and Prevention website.

During the “welcome to Medicare” visit, you should:

• Perform a health risk assessment
• Record your patient’s medical and social history (like alcohol or tobacco use, diet and activity level)
• Check height, weight and blood pressure
• Calculate body mass index
• Perform a simple vision test
• Review potential risk for depression and patient level of safety
• Offer to talk about creating advance directives
• Educate the patient on preventive services needed and prescribe appropriate services
• Create a screening schedule (checklist) for appropriate preventive services

Annual wellness visit
The annual wellness visit is a chance for you to develop or update your patient’s personalized prevention plan based on his or her current health situation and risk factors. Health risk assessments are also part of the annual wellness visit. The assessment consists of self-reported information from your patient to be completed before or during the visit.

Medicare will cover an annual wellness visit every 12 months for patients who’ve been enrolled in Medicare for longer than 12 months. Patients can schedule their annual wellness visit on the same day or coordinate it with their routine physical exam (see below) to help give you a complete view of their health.

Services at the annual wellness visit include:

• Health risk assessment
• Review of medical and family history
• Develop or update a list of current providers and prescriptions
• Height, weight, blood pressure and other routine measurements
• Detection of any cognitive impairment
• Personalized health advice
• A list of risk factors and treatment options
• Education on preventative services needed and prescribe appropriate services
• A review and update of the screening schedule (checklist) for appropriate preventive services

Routine physical exam
The routine physical exam is typically covered annually by the patient’s Medicare Advantage health care plan. These exams are part of preventive services that aren’t part of the welcome to Medicare visit or annual wellness visit.

Routine physical exams are used to get information about the patient’s medical history, family history and perform a head-to-toe assessment with a hands-on examination to assess your patient’s health, address any abnormalities or signs of disease. Routine physical exams should include the following:

• A visual inspection
• Palpitation
• Auscultation
• Manual examination

Care plans
These preventive visits are an excellent opportunity for you and your patients to plan their care for the year. Care plans should include a schedule for preventive services and health screenings, many of which are required annual services to meet Healthcare Effectiveness Data and Information Set, commonly known as HEDIS^® specifications.**

You’ll need to recommend and prescribe — or refer your patient for needed preventive services — that apply to his or her care plan. Some examples of preventive services include:

• Colon cancer screening
• FOBT yearly
• Sigmoidoscopy every five years
• Colonoscopy every 10 years
• Cologuard every three years
• Breast cancer screening
• Mammography every two years
• Osteoporosis testing in older women
• Bone mineral density testing in women ages 65-85 every two years
• Comprehensive diabetes care
• A1c blood sugar screening — two to four times per year
• Urine microalbumin screening — yearly
• Retinal eye exam — every other year if negative or every year if positive

These visits also provide a great opportunity to review or create a risk assessment for your patients, including a full list of their long-term chronic conditions. This will help your patients take advantage of disease and care management programs, as well as prevention initiatives.

This benefits both you and your patient by:

• Uncovering care management opportunities
• Identifying practice patterns
• Managing patient medications better
• Reducing avoidable hospital admissions

For more information on risk adjustment and HEDIS best practices, refer to our online provider manuals — and keep an eye out for more newsletter articles coming your way throughout the year.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.

**HEDIS^®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance.