Wiki Humana Medicare and AWV

[hsmith67]

I'm being told by a CPC at Humana that Humana requires the Humana Medicare Annual Wellness/Subsequent Annual Wellness to be performed by a clinician (MD/DO/PA/NP). I presented 2 links from CMS that clearly/explicity state it can be done by:
"Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of medical professionals directly supervised by a physician (doctor of medicine or osteopathy)"

When I pressed for what she is hanging her hat on to say a licensed clinician is required to perform the AWV she responded with a link to Medicare Managed Care Manual, Chapter 7 Risk Adjustment, Table 19. Table 19 identifies clinical provider types eligible for services that "risk adjust". https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c07.pdf

Can I get some input from someone that the AWV must be performed by a clinician and cite your source? I have multiple CMS sources that tell me this can be done by 'non-clinicians/non NPP's' from CMS documents.

Thanks for any help anyone can provide,
Hunter Smith, CPC

 

[Pathos]

You are both correct, but for different scenarios/reasons.

1) You state that the AWV can be performed by a "Medical professional", and that is correct.
2) The Humana rep is stating that a "licensed provider" has to be one of CMS recognized Risk Adjustment providers. This is also correct.

Conclusion:
While a "medical professional" can perform the AWV, the only providers that will be recognized for Risk Adjustment purposes are the ones listed on CMS' approved provider list. This further means that if an RN (or other performs an AWV, you cannot use that visit towards Risk Adjustment. It will simply be denied if audited.


Hope that helps!