Health History Revenue Series: Integrating Key Tasks into Health History Processes to Generate Revenue and Reduce Staff Burden

According to the American Hospital Association, many healthcare systems are experiencing lower revenue and/or staffing shortages.

To tackle these problems, we will be posting a "Health History Revenue Series" in our Value-Based Care Newsletter with the goal of launching innovative ideas to tackle 1) revenue generation; and 2) automation in the electronic health records system to reduce staff burden.

Annual Wellness Visit (AWV) and Advance Care Planning (ACP)

Annual wellness visits are the vital component in patient preventive care plans in to achieve successful health outcomes. Along with the annual wellness visit, the advance care plans should also be addressed every 12 months. With unpredictable life changes, it is important that patients have up-to-date preventive care services and legal documentation regarding their medical care and end of life requests.

Instead of viewing these tasks as a burden, these tasks should be embraced along with the related revenue by integrating these key patient care tasks into your health history intake processes.

Advance Care Planning (ACP) is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Coding

Use these CPT codes to file ACP claims as an optional AWV element:

99497

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

99498

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Diagnosis

You must report a diagnosis code when submitting an ACP claim as an optional AWV element. Medicare does not require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

Billing

Both the Part B ACP coinsurance and deductible are waived when:

• Provided on the same day as the covered AWV
• Provided by the same provider as the covered AWV
• Billed with modifier –33 (Preventive Service)
• Billed on the same claim as the AWV

The ACP deductible and coinsurance are waived once per year when billed with the AWV. The deductible and coinsurance are applied when the ACP is delivered outside of the covered AWV.

By combining AWV and ACP into one visit, the revenue is increased for the encounter.

Digital Health History Form

To tackle the staffing shortages, all key information should be prompted from the patient using a digital health history form that imports their claims and clinical data and supplies key responses to streamline both the AWV and ACP processes.

Contact me to learn more about integrating revenue into health history intake processes.

Kris Gates, [email protected]