tci Medicare Compliance & Reimbursement - 2020 Issue Q4
Compliance: Master AWVs With Tips from the Experts
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Article Overview
This premium article explains Medicare annual wellness visit (AWV) compliance in the context of documentation, audit readiness, and reimbursement integrity. It is aimed at coders, billers, compliance staff, and clinicians who perform or support AWVs, including specialists. The discussion focuses on general AWV timing, required documentation elements, screening history, cognitive and functional assessment, provider/supplier lists, and the role of CGS Medicare guidance and CERT/TPE review activity.
Why This Topic Matters
AWVs are a recurring Medicare service that can trigger claim denials or audit issues when documentation is incomplete or timing requirements are missed. Understanding the article helps practices reduce preventable errors and better support compliant AWV billing and records.
Article Sections
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Don’t Forget the AWV Timeline
Discusses the general Medicare timeline and eligibility context for annual wellness visits. It also notes the broader distinction between initial and subsequent AWV reporting.
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Always Document Scheduled Screenings
Covers the need to maintain screening histories and future screening schedules in the medical record. The section relates to preventive service planning and audit review expectations.
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Maintain Cognitive Function Assessment
Addresses documentation expectations for cognitive assessment and relevant medical and family history elements. It also references broader history-taking components tied to AWV records.
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Always Maintain List of Providers, Suppliers
Explains that current care team and supplier information should be documented as part of the AWV record. The section focuses on maintaining a complete beneficiary care-provider list.
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Be Sure to Record Functional Ability
Describes the need for documentation related to functional status and safety. It includes general observational and screening considerations used in AWV documentation.
What You Will Learn
- How Medicare AWV timing and eligibility are framed in general terms
- Which documentation elements are commonly reviewed in AWV audits
- What types of preventive screening information should be maintained
- Why cognitive, functional, and care-team documentation matter for AWVs
- How audit and review activity can affect AWV claim scrutiny
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Primary care clinicians
- Specialists performing preventive services
- Practice managers
Codes Discussed
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