Do you have time for a Quality Minute?

Quality Minute will be an ongoing series of quick tips designed to be read in 60 seconds or less and provide your practice with information about performance in key areas.

Medicare wellness visits

• An annual wellness visit, or AWV, is the most crucial visit for your Medicare Advantage members’ quality of care, and it’s a component of contracts and incentive programs.
• AWVs can be scheduled anytime during the calendar year, regardless of the member’s previous AWV. This means you do not have to wait 365 days from the previous AWV. Every Medicare Plus Blue℠ and BCN Advantage℠ member is eligible for an AWV starting Jan. 1 of the new year.
• AWVs can be completed and billed on the same day as an annual physical exam (*99385-*99387, *99395-*99397) or an evaluation and management service (*99202-*99215) if all components of both visits are met, including all medical record documentation guidelines. Add modifier 25 to the physical or E/M code. Members should be informed that there may be costs associated with services billed in addition to the AWV.
• When an AWV is completed virtually with an E/M code, both video and audio are required.

For more information

Refer to the Medicare Wellness Visits tip sheet. Here’s how to find it:

1. Log in to our provider portal (availity.com.)**
2. Click Payer Spaces on the menu bar, and then click the BCBSM and BCN logo.
3. Click the Resources tab.
4. Click Secure Provider Resources (Blue Cross and BCN).
5. Click Member Care on the menu bar, and then click Clinical Quality and Tip Sheets.

Review medications at every patient visit

• Remind patients to bring their medications to each visit. You can add this to your messaging for appointment reminders.
• Use a standard phrase, such as “I’m going to review your medications.” This will help patients remember the review if they receive a CAHPS survey asking about this later.
• The medical record must include the name of the person who reviewed the medications with the patient and the date of review.

Cost, side effects and barriers to pharmacy pickup may affect medication adherence

• Remind patients to use their pharmacy benefits when paying for medications.
• Prescription drug prices under a patient’s pharmacy coverage is typically more cost-effective than discount programs, especially for generic medications.
• Use of discount programs will not count toward pharmacy quality gaps, such as medication adherence.
• Ninety-day mail order prescriptions are the gold standard to ensure patients adhere to their medication regimens.
• All active diagnoses should be submitted on claims annually to exclude members from quality measures for which their diagnoses make medications intolerable.

By following these simple tips, you’ll improve patients’ experience measured by several Medicare Star measures.

For more information, refer to the Medication Adherence Star measure tip sheet.

CAHPS^®, Consumer Assessment of Healthcare Providers and Systems, is a registered trademark of the Agency for Healthcare Quality and Research.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.