What are Medicare Preventive Visits? 

Use this toolkit to leverage best practices in implementing an annual comprehensive visit program within your healthcare practice. Please click here to contact us if you have any questions regarding any of these materials.

What is an AWV?

The Medicare Annual Wellness Visit (AWV) is an in-office visit enabling healthcare providers to develop a comprehensive picture of a patient’s health risk, goals and barriers. Diagnostic components such as depression screening and functional assessment help to design a personalized treatment plan focused on patient wellness and preventive care.

What is an APPE/CPE?

The Annual Preventive Physical Exam (APPE)/Comprehensive Physical Exam (CPE) is an in-office visit enabling healthcare providers to collect age and gender-appropriate medical history, provide guidance on reducing healthcare risk factors, and order any laboratory or diagnostic procedures that may be required for patient care.

It is important to note that an annual preventive physical exam is Humana Medicare Advantage plan benefit and is not covered by Original Medicare.  The information provided on this website is intended to be applied only to Humana Medicare Advantage members. 

What is an Annual comprehensive visit?

An Annual comprehensive visit combines the Medicare AWV and the APPE/CPE into one visit for your patients.

Conducting a physical exam together with an AWV offers multiple benefits to you and your patients whose benefits include an APPE/CPE.

Patients may experience improved health outcomes and greater satisfaction with their medical care while saving time and money.

Patients may experience improved health outcomes and greater satisfaction with their medical care while saving time. Practices may see greater medication adherence and improved treatment compliance, in addition to improving quality measures such as Healthcare Effectiveness Data Information Set (HEDIS®) and Stars. Statistics support the combining a physical exam with an AWV: 1

10% increase in Healthcare Effectiveness Data Information Set HEDIS® scores
9% increase in re-documentation of chronic conditions year over year
3% increase in follow-up clinical visit rates
1The data is based on a Humana study conducted by the Intermountain Region (IMR) Idaho, Oregon, Utah, and Washington using year to date (YTD) claims for Current Procedural Terminology (CPT) codes—in this case after an annual comprehensive visit. IMR data used the re-documentation claims data from Jan. 1 – Nov. 5, 2018, CPT codes G0438 - G0439 and 99397 (or age-appropriate CPT code), to determine the recapture rate and the quality pass rates for individuals who had an annual comprehensive visit versus those who did not have an AWV or preventive physical visit. Clinical follow-up after the comprehensive visit looked at members with CPT codes who had a follow-up visit categorized by E/M codes or other identifying face-to-face service, 99211– 99214 for example, to determine the percentage of members returning for a follow-up visit.
 
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