Open Forum

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Emily.  Yes, we are doing the same with setting up a process to have the sequential AWVs done by RNs.  I am in the middle of writing a policy for protocol orders allowing RNs to be able to place orders as a result of identified care gaps.  That order will go to the primary provider for signature.  We also have a dedicated NP in our primary care office who will sign them off as well.

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Stacy -

Does the patient have a visit with a clinician in connection with the RN visit? i.e. within a certain time always from the clinician visit? 

Also how are they getting the orders to the clinicians for signature?

Thank you!  Emily

Hi Emily.  Yes, we are doing the same with setting up a process to have the sequential AWVs done by RNs.  I am in the middle of writing a policy for protocol orders allowing RNs to be able to place orders as a result of identified care gaps.  That order will go to the primary provider for signature.  We also have a dedicated NP in our primary care office who will sign them off as well.

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Stacy -

Does the patient have a visit with a clinician in connection with the RN visit? i.e. within a certain time always from the clinician visit? 

Also how are they getting the orders to the clinicians for signature?

Thank you!  Emily

Hi Emily.  Yes, we are doing the same with setting up a process to have the sequential AWVs done by RNs.  I am in the middle of writing a policy for protocol orders allowing RNs to be able to place orders as a result of identified care gaps.  That order will go to the primary provider for signature.  We also have a dedicated NP in our primary care office who will sign them off as well.

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Emily.  Yes, we are doing the same with setting up a process to have the sequential AWVs done by RNs.  I am in the middle of writing a policy for protocol orders allowing RNs to be able to place orders as a result of identified care gaps.  That order will go to the primary provider for signature.  We also have a dedicated NP in our primary care office who will sign them off as well.

------------------------------
Stacy Sanchez
Temple
Philadelphia PA
(973)900-4363

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Hi Emily.  Yes, we are doing the same with setting up a process to have the sequential AWVs done by RNs.  I am in the middle of writing a policy for protocol orders allowing RNs to be able to place orders as a result of identified care gaps.  That order will go to the primary provider for signature.  We also have a dedicated NP in our primary care office who will sign them off as well.

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Emily are these billable services for the RN?  Thank you

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Emily are these billable services for the RN?  Thank you

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819
------------------------------

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819
------------------------------

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819
------------------------------

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Hi Lisa; 

Take a look at this under the 'Health Professional' section:

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.15

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

Can someone tell me where it is documented that this is an RN billable service? I can't find it on the CMS website any where.

Thanks in advance!

------------------------------
Lisa Bronson RN
Care Manager
Wallowa Memorial Med Clinic
Enterprise OR
(615)337-7819

Original Message:
Sent: 06-12-2023 18:34
From: Rebekah Sherman
Subject: RN Led Medicare Annual Wellness Visits

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

------------------------------
Rebekah Sherman
Director of Nursing
La Clinica de Valle
Medford OR
(541)221-3040

Original Message:
Sent: 06-10-2023 17:50
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Original Message:
Sent: 6/10/2023 2:16:00 PM
From: Leslie Robinson
Subject: RE: RN Led Medicare Annual Wellness Visits

Emily are these billable services for the RN?  Thank you

------------------------------
Leslie Robinson DNP, MSN, RN
LGR Associates, LLC
Silver Spring MD
(240)750-9059

Original Message:
Sent: 06-08-2023 12:12
From: Emily Newbury
Subject: RN Led Medicare Annual Wellness Visits

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

------------------------------
Emily Newbury, PDN
Gundersen Health System

------------------------------

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

Emily are these billable services for the RN?  Thank you

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Rebekah would it be possible for you to share your tools with me I lie in rural area and I am just starting a clinic job as a manager with nothing in place. I feel like I need some tools to help with this big task Thank you 

ogrady.donna@icloud.com 

Thank you 
Donna OGrady 

We just started RN led visits.  We do a pre-visit huddle with RN and PCP and only schedule follow up PCP visits as needed.  We don't have a standing protocol but I like that idea. Our population health team screens in advance for care gaps. For billing the RN completes the visit but does not sign it. The provider reviews the visit notes, signs any orders/meds refills and documents they approve the preventative plan of care and signs visit.

One thing that maybe everyone else figured out super easy but took me awhile, is if the provider actually has to lay eyes on the pt.  I could not find anywhere in the CMS rules that this is true.  It seems only to be true for Rural Community health clinics.  We are an FQHC and the provider must be in the building but not in the room.

Some tools we developed were: workflow (for RN or MA assisting a provider) pre-visit worksheet, and EPIC dotphrase.  We also matched the pre-visit HRA form we send to pt's to line up with the questions in the EPIC flowsheet.  It's an EPIC letter template so it pulls in all their meds and hx and asks them if what we have on file is correct.

Emily are these billable services for the RN?  Thank you

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Emily;

This thread went into depth regarding the Annual Wellness Visits with lots of great input from colleagues. Now that I look at your question again, are you seeking to provide other types of 'RN -led' visits?

I have also separately emailed leadership at AAACN asking if there is a consultant available to the organization who can advise for the variety of coding and billing questions that come through the list serv. No response just yet.

Leslie

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hi Emily;

This thread went into depth regarding the Annual Wellness Visits with lots of great input from colleagues. Now that I look at your question again, are you seeking to provide other types of 'RN -led' visits?

I have also separately emailed leadership at AAACN asking if there is a consultant available to the organization who can advise for the variety of coding and billing questions that come through the list serv. No response just yet.

Leslie

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

We are doing nurse AWVs. While having an independent nurse schedule is ideal, we have gotten only as far as the "coupled" model with the provider visit. Nurse only does subsequents, no initials. We are on Cerner and have built a Quickvisit for which the nurse can select orders including the G0439 and goes through without having to "propose" for provider to approve. This privilege is coupled with standing orders and AWV protocol for the nurse to follow.

Sherrie Bragg, MSN, BS, RN, AMB-BC, NEA-BC

Assistant Vice President, Clinical Care & Quality

Atlanticare

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance - 

Sherrie,

Thank you for this information!

Could you share your standing order set for AWVs?

Thanks,
M

 

Melissa Taylor, BSN, RN, AMB-BC, NE-BC

Director of Ambulatory Nursing-Primary Care

(603) 663-3503 (office)

(603)663- 3500 (fax)

 

 

This document contains information constituting records and/or testimony relating to activities of a quality assurance committee and is therefore protected from direct or indirect means of discovery, subpoena, or admission into evidence in any judicial or administrative proceeding, pursuant to NH RSA 151:13-a and/or RSA 329:29-a.

 

 

We are doing nurse AWVs. While having an independent nurse schedule is ideal, we have gotten only as far as the "coupled" model with the provider visit. Nurse only does subsequents, no initials. We are on Cerner and have built a Quickvisit for which the nurse can select orders including the G0439 and goes through without having to "propose" for provider to approve. This privilege is coupled with standing orders and AWV protocol for the nurse to follow.

Sherrie Bragg, MSN, BS, RN, AMB-BC, NEA-BC

Assistant Vice President, Clinical Care & Quality

Atlanticare

Hello - 

We have been completing Medicare Annual Wellness Visits for over a year.

We are looking to continue to enhance our current process and continue to allow our nurses to work up to their highest scope. We currently have a small list of orders that our nurses are placing and signing. Does any one have a standing order set for the RN led visit?

Currently our RN visits are occurring a few weeks prior to a clinician visit, has anyone decoupled the RN visit from an associated clinician visit? 

Thanks in advance -