Home Forums Discussions General Discussion Templates for welcome to Medicare and annual Medicare exam

Does anyone have these that they are able to share? If it is too difficult to upload, perhaps emailing me Singla.a@drsingla.com
Thanks!

This stuff is a little dated, so you might want to check against current requirments by Medicare.

HPI:
This patient is here for %his Initial Annual Wellness visit with Medicare. %He is out of the time limit for the Initial Preventive Exam (Welcome to Medicare). %FNAME reports being in good health.
Other Providers:
Vision Test: Left ( ) Right ( )

PMH:
Pneumovax (rec once >65):
Tdap (rec every 10 years):
Influenza (rec yearly):
Mammogram (rec yearly females):
PSA (rec yearly males): [no longer covered]
DEXA (rec q2 years):
Colon CA Screening:
Due Date for Next:
Advanced Directive: Y/N
Tobacco Use (rec no smoking): Y/N
(smoking increases risks of death, MI, CVA, and CA)

Assessment:
# ROUTINE GENERAL MEDICAL EXAMINATION AT A HEALTH CARE FACILITY (V70.0): AWV: Initial, peformed. The plan of care is as follows in the plan section.
Cognition: Recall of three words normal.
Depression Score: Patient has no depression
Functional Ability: Normal Up & Go test, normal ADL screen, normal walk safety screen, normal hearing screen.
All of questions %Mr %LNAME had were answered.
V77.1, V77.91
Initial: G0438
Subsequent: G0439

Plan:
Personalize Prevention Plan of Service (PPPS)

Vaccines (PNA once >65, Inf yearly, Hep B med/high risk):
Prostate Ca Screen (annually to 75 yo):
Colon CA Screen (to 75 yo):
Glaucoma Screen:
CVS Screening Labs (every 5 years):
DM Education:
DM Screening Labs (every 3 years, prediabetic 6mo):
AAA (once for men 65-75 smoked >100 cigs, anyone with FH of AAA, may be only covered at Welcome Visit):
HIV (inc risk patients): n/a
Smoking Cessation (8 cessions per year): Smokers should quit: this increases risk for lung disease and cancers, early death.

Subsequent AWV: Recommended 1 year.

The above response does not capture all the details required for compliant documentation. Visit below for medicare guidance information:

http://www.cms.gov/Outreach-and-Edu...s/MLN-Publications-Items/CMS1243320.html

My practice uses www.MyPHTS for interactive web-based compliant patient-centered assessments. The MyPHTS Annual Health & Wellness assessment and its associated provider report are compliant. You would just need to add the diligence of your compliant physical exam.

Sincerely,
MKO

As you shoot it down, MKO, maybe you would like to add what is missing so folks can use that. Go ahead an contribute. It's just the skeleton of a template. Obviously AC includes Social History and other elements. Can you name something that is missing here?

Hello Boondoc,

I was not trying to shoot down the help you were offering. Sorry if my brevity came off like that. The expectation for the medicare wellness exam is just much more detailed than many of us would think of for a typical physical exam. I was surprised myself when I researched on it. The help I was offering was direction to a very nice educational outreach document put out by medicare. It is a checklist of their requirements as well as guidance for billing it. I use the MyPHTS assessments because some patients/families can complete the assessments on their own prior to the office visit and my MAs can help others during the office visit. I round up after I've enlisted my MA's help. I can't remember everything on the check list of medicare expectation of the top of my head nor do I have the time or interest for documenting the thing from scratch by myself. So I leverage MyPHTS templates. Others I know use paper forms for the assessments that patients complete, but then they have to scan into their emr into imported items. Then also like you are suggesting you could develop a template within your emr which you would go through the lengthy process of interviewing the patient yourself.

Anyway to avoid omissions, I thought it would be helpful to just direct others to the source of information.

As brief examples: you would need to use an accepted screening instrument recognized by national professional medical organizations for depression such as PHQ-9 or PHQ-2; review beneficiary functional ability and safety level (fall risk, ADLs, hearing impairment, home safety); use of or exposure to medications and supplements including calcim and vitamins, etc ...

Anyway hope this helps Abhin and others that are interested.

And again, sorry Boondoc . . . I think we're all trying to help each other here.

Have a good evening.

Sincerely,
MKO

I think the bottom line is that the Medicare Wellness series are another good idea spoiled by bureaucratic over-reach.
I have pretty much stopped doing them -- they are a waste of time, and don't reimburse adequate for time invested.
Ditto for chronic care management, Home Health management, Hospital Transition of Care and all the rest.
Once in a while, if you play the cards just right, you can make a little money.

MKO: No hard feelings. Perhaps they will not consider it adequate that I said the "Patient has no depression." But then again, I'm the doctor and I said so. Bureaucrats try to ruin everything. I'm so angry with my Fam Med Academy. They hailed the government of giving us a "win" on the transition of care, but as we can all see it is a big joke. There's no way my patients are going to pay a fee for this. It's such a clear example of how they killed it accidentally with the red tape, or how they made it impossible/inefficient enough so they will not have to be paying on purpose. They truly do not want to fix the system, or they would convene doctors to tell them these problems. We need a new system and new leadership.

I would like to perfect the template if possible. Does anyone else want to add to it?

Chris - how has the template for the Medicare visits progressed?

I'm in sunny Santa Fe, NM this week transitioning a practice with a clinical conversion from Benchmark to AC.

They have a large retired population, so getting templates for the G0402, G0438, G0439 would be helpful.

I don't often get the chance to ask clinical questions, so this is fun to ask what is probably a newb request.

For the record it is sunny, dry, and in the sixties today.

Here is a template I created based on the form on AAFP.org
http://www.aafp.org/fpm/2012/0300/fpm20120300p11-rt1.pdf
for health risk assessment

EDIT it by exclusion

Medicare wellness checkup.
1. What is your age?
65 - 69.
70-79.
80 or older.

2. Are you a male or a female?

Male.
Female.

3. During the past four weeks, how much have you been bothered by emotional problems such as feeling anxious, depressed, irritable, sad, or downhearted and blue?

Not at all.
Slightly.l
Moderately.
Quite a bit.
Extremely.

4. During the past four weeks, has your physical and
emotional health limited your social activities with family friends, neighbors, or groups?

Not at all.
Slightly.
Moderately.
Quite a bit.
Extremely.

5. During the past four weeks, how much bodily pain have you generally had?

No pain.
Very mild pain.
Mild pain.
Moderate pain.
Severe pain.

6. During the past four weeks, was someone available to help you if you needed and wanted help?
(For example, if you felt very nervous, lonely, or blue; got sick and had to stay in bed; needed someone to talk to; needed help with daily chores; or needed help just taking care of yourself.)

Yes, as much as I wanted.
Yes, quite a bit.
Yes, some.
Yes, a little.
No, not at all.

7. During the past four weeks, what was the hardest physical activity you could do for at least two minutes?

Very heavy.
Heavy.
Moderate.
Light.
Very light.

8. Can you get to places out of walking distance without help? (For example, can you travel alone on buses or taxis, or drive your own car?)

Yes.
No.

9. Can you go shopping for groceries or clothes without
someone?s help?
Yes.
No.

10. Can you prepare your own meals?
Yes.
No.

11. Can you do your housework without help?
Yes.
No.

12. Because of any health problems, do you need the help of another person with your personal care needs such as eating, bathing, dressing, or getting around the house?

Yes.
No.

13. Can you handle your own money without help?
Yes.
No.

14. During the past four weeks, how would you rate your health in general?

Excellent.
Very good.
Good.
Fair.
Poor

15. How have things been going for you during the past
four weeks?
Very well; could hardly be better.
Pretty well.
Good and bad parts about equal.
Pretty bad.
Very bad; could hardly be worse.

16. Are you having difficulties driving your car?
Yes, often.
Sometimes.
No.
Not applicable, I do not use a car.

17. Do you always fasten your seat belt when you are in a car?
Yes, usually.
Yes, sometimes.
No.

18. How often during the past four weeks have you been bothered by any of the following problems?

Falling or dizzy when standing up.
Never
Seldom
Sometimes
Often
Always

Sexual problems.
Never
Seldom
Sometimes
Often
Always

Trouble eating well.
Never
Seldom
Sometimes
Often
Always

Teeth or denture problems.
Never
Seldom
Sometimes
Often
Always

Problems using the telephone.
Never
Seldom
Sometimes
Often
Always

Tiredness or fatigue.
Never
Seldom
Sometimes
Often
Always

19. Have you fallen two or more times in the past year?

Yes.
No.

20. Are you afraid of falling?
Yes.
No.

21. Are you a smoker?

No.
Yes, and I might quit.
Yes, but I?m not ready to quit.

22. During the past four weeks, how many drinks of wine, beer, or other alcoholic beverages did you have?
10 or more drinks per week.
6-9 drinks per week.
2-5 drinks per week.
One drink or less per week.
No alcohol at all.

23. Do you exercise for about 20 minutes three or more days a week?

Yes, most of the time.
Yes, some of the time.

No, I usually do not exercise this much.
24. Have you been given any information to help you with the following:
Hazards in your house that might hurt you?
Yes.
No.

Keeping track of your medications?
Yes.
No.

25. How often do you have trouble taking medicines the way you have been told to take them?

I do not have to take medicine.
I always take them as prescribed.
Sometimes I take them as prescribed.
I seldom take them as prescribed.

26. How confident are you that you can control and manage most of your health problems?

Very confident.
Somewhat confident.
Not very confident.
I do not have any health problems.

27. What is your race? (
Check all that apply.
White.
Black or African American
Asian.
Native Hawaiian or other Pacific Islander.
American Indian or Alaskan Native.
Hispanic or Latino origin or descent.
Other

Hi All, I'm looking at updating the templates for AWV within Amazing Charts and would welcome some insight. Do you use templates for the AWV? One or several? For which components do you use a template; the Health Risk Assessment , Updated written screening schedule, Updated document with risk factors/treatments/etc, Updated personalized health advice? What are your pain points around workflow/documenting? Thanks in advance.

Dear Cathy I have previously requested that we have the decision support window show a filter for Maintenance Physicals

Colonoscopy, Mammogram, Pap Smear, Dexa scan and others in a window to show them as completed Similar to the immunizations



Also can the decision support and their dates completed be added in the letter writer so that a scheduled be given to the patient of date of completed and when next date maintenance is due

Thanks for the suggestions Sunil, both important to the AWV work flow. I will continue to gather information and let you know when we determine our best approach.
Regards
Cathy