May 2020
New Annual Wellness Visit Resources for Medicare Providers
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 do not need to be returned to us.
What’s New?
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 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 is 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 BCBSNM ID card and a driver’s license or other photo ID to help guard against medical identity theft.
1 Centers 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).
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. Aerial, iExchange and Medecision® are trademarks of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. 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.