Advance Care Planning and the Medicare Annual Wellness Visit

Advance Care Planning and the Medicare Annual Wellness Visit

On December 22nd, 2015, the Centers for Medicare & Medicaid Services (CMS) released MLN Matters document MM9271[1]. The document explains how Advance Care Planning (ACP) can be an optional element of an Annual Wellness Visit (AWV) for your Medicare patients.

Starting January 1st, 2016, Medicare will cover ACP as a voluntary element during the Annual Wellness Visit. It is voluntary for both the provider – to choose to include questions to initiate a discussion about ACP with the patient, and for the patient – to choose to indicate an interest to move forward with ACP discussions.

Advanced Care PlanningThe ACP is an opportunity for any qualified health care professional, such as MD, DO, NP, or PA, or those with the training necessary, such as an RN or Licensed Masters Social Workers (LMSWs) [2], to discuss with their patients the best available health care options for end-of-life care, for the patient to determine the type of care that will fit the patient’s personal wishes, and for the patient to choose who would act as their medical proxy.  The discussions also include sharing these wishes with the patient’s family, friends, and other providers. This must be a face-to-face service, between the healthcare professional and the Medicare patient, provided by the health care professional.

According to a Kaiser Family Foundation survey[3], 89 percent of adults would like for doctors to discuss end-of-life care issues with their patients, but only 27 percent of adults, 65 and older, have actually had these discussions. WellTrackONE advocates for these discussions.

WellTrackONE can incorporate into a clinic’s Annual Wellness Visit software the opportunity to discern if the Medicare patient would like to discuss Advance Care Planning with a qualified health care professional. The AWV template has two new queries that ask the patient if they would like to discuss with their provider their own priorities regarding medical treatment in the event that they become seriously ill and are unable to make their own decisions. The first asks if the patient would like to discuss with their physician about healthcare options and the wishes for their medical care should they not be able to make those decisions anymore.  The second asks if the patient would like to discuss with their physician, who would make medical decisions for them, should they not be able to make their healthcare decisions for themselves.If the patient indicates that they are interested in having these discussions and would like to speak to a qualified health professional about ACP, then a WellTrackONE Clinic Trigger™ will alert the provider that the patient would like to have this discussion.

When performed in conjunction with the Annual Wellness Visit, Medicare will reimburse an average of $81 for the first 30 minutes of an ACP (code 99497) and an additional $70 for every 30-minutes thereafter (code 99498). When submitting a claim for both the AWV and ACP, the provider must use modifier 33. This means that the provider now has the opportunity to receive the average reimbursement of $173 for the Annual Wellness Visit plus $80 for Advance Care Planning for a total of $253.

Medicare will waive the beneficiary’s deductible and coinsurance when the ACP is furnished in conjunction with the AWV.  If the Advance Care Planning is not performed on the same day as the Annual Wellness Visit, the deductible and coinsurance will apply for the patient, but the reimbursement to the practice will remain the same.

CMS understands the need to expand the opportunity for health care professionals to discuss Advance Care Planning with their patients, thus allowing it to be initiated as an optional element of the Annual Wellness Visit.


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