Posted May 1, 2020
We have two new resources to help you care for our Medicare Advantage members during their annual wellness visits: an Annual Wellness Visit Guide and Annual Wellness Visit form. These resources can help you document our members’ visits to more easily meet Medicare requirements. The guide and form are for your use only and don’t need to be returned to us.
The Annual Wellness Visit Guide includes a wellness visit checklist and information on:
- Medicare coverage for wellness visits
- Correct coding for wellness visits
- Guidance to help ensure all member conditions are correctly coded each year
- Coding for other evaluation and management services, such as lab tests
- Preventive services and screenings
- Closing care gaps by performing Healthcare Effectiveness Data and Information Set (HEDIS®) measurements
- Coding tips to help minimize requests for medical records and help expedite claims processing
You may find it helpful to use the new Annual Wellness Visit form during wellness visits. It includes sections for members’ medical history, risk factors, conditions, treatment options, coordination of care and advance care planning. It can be used as a digital fillable form or printed and completed by hand during the visit.
Annual Wellness Visits Help Our Members Stay Healthy
Wellness visits provide opportunities to screen for health conditions and manage chronic ones. To support our members’ health, you can:
- Remind them to schedule their annual wellness visit for 2020
- Discuss behavioral and physical health and preventive measures such as healthy weight, fall prevention, diet and exercise
Members may be able to earn a reward for getting an annual wellness exam and other screenings. An initial preventive visit and subsequent annual wellness visits have no copay and are provided at no additional out-of-pocket cost for Medicare Advantage members.1 See our guide for more information. Additional services may result in member cost-sharing.
It’s important that you use the Availity® Provider Portal or your preferred vendor to check eligibility and benefits before every scheduled appointment. Eligibility and benefit quotes include membership confirmation, coverage status and applicable copayment, coinsurance and deductible amounts. Ask to see the member’s Blue Cross and Blue Shield of Illinois (BCBSIL) ID card and a photo ID to help guard against medical identity theft.
1Centers for Medicare & Medicaid Services, Yearly "Wellness" visits, https://www.medicare.gov/coverage/yearly-wellness-visits
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Availity. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit. Not all benefits are offered by all benefit plans. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. For more complete details, including benefits, limitations and exclusions, please refer patients to their certificate of coverage. If you have any questions, please call the number on the member’s ID card. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.