Many people have a friend or relative who has fallen. The person may have slipped while walking or felt dizzy and fallen when standing up from a chair. Maybe you've fallen yourself. If you or an older person you know has fallen, you're not alone. Nearly half of all people age 65 years or older fall each year. While age is not a fall risk unto itself, the risk of falling -- and fall-related problems -- rises with age. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths. Hip fractures are one of the most serious types of fall injury. They are a leading cause of medical problems and death among older adults. Only half of older adults hospitalized for a broken hip can return home or live on their own after the injury.
Many older adults are afraid of falling. This fear becomes more common as people age, even among those who haven't fallen. It may lead older people to avoid activities such as walking, shopping, or taking part in social activities. If you fall, be sure to discuss the fall with your doctor, even if you aren't hurt. Many underlying causes of falls can be treated or corrected. For example, falls can be a sign of a problem with your medicines that can be corrected. They can also be a sign of a manageable disease or other problem, such as diabetes or low blood pressure when you stand.
Falls don't "just happen," and people don't fall because they get older. Often, more than one underlying cause or risk factor is involved in a fall. A risk factor is something that increases a person's risk or susceptibility to a medical problem or disease.
"After decades of having all kinds of doctors tell me that they could find nothing wrong...I finally found relief for my intense feelings of vertigo...nauseau and spinning with Fall Prevention Clinics of America." Mrs. Anne P. - Naperville,IL.
"I had dizziness and walked like I had too much to drink. After visits to several hospitals and physicians, I was referred to Fall Prevention Clinics of America by an ENT physician. Now I can feel steady when I walk, and I'm no longer afraid of falling" Don W.-Berwyn, IL
"I fell a year or so ago, and my balance was not very good. My primary care doctor referred me to Fall Prevention Clinics of America. They have helped me a great deal, and I would refer them to anyone." Mrs. Milda C.-Naperville,IL
Medicare's Annual Wellness Visit
Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
MLN Matters MLN Matters® Number: MM7079 Revised Effect ive Date: January 1, 2011 Provider Types Affected
This article is for physicians, non-physician practitioners, and providers submitting claims to Medicare contractors (carriers, Medicare Administrative Contractors (MACs), and/or Fiscal Intermediaries (FIs) for services provided to Medicare beneficiaries.
Provider Action Needed
The Affordable Care Act provides for an Annual Wellness Visit (AWV), including Personalized Prevention Plan Services (PPPS) for Medicare beneficiaries as of January 1, 2011. CR 7079 provides the requirements for the AWV, which are summarized in this article. Make sure billing staff are aware of these services and how to bill for them.
What is Included in an Initial AWV with PPPS?
The initial AWV providing PPPS provides for the following services to an eligible beneficiary by a health professional:
Establishment of an individual’s medical/family history.
Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.
Measurement of an individual’s height, weight, BMI (or waist circumference, if appropriate), BP, and other routine measurements as deemed appropriate, based on the beneficiary’s medical/family history.
Detection of any cognitive impairment that the individual may have as defined in this section.
Review of the individual’s potential (risk factors) for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.
Review of the individual’s functional ability and level of safety based on direct observation, or the use of appropriate screening questions or a screening questionnaire, which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations.
Establishment of a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP), as well as the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.
Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE, and a list of treatment options and their associated risks and benefits.
Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
Voluntary advance care planning (as defined in this section) upon agreement with the individual.
Any other element(s) determined appropriate by the Secretary of Health and Human Services through the National Coverage Determination (NCD) process.
What would be Included in a Subsequent AWV/PPPS?
In subsequent AWVs, the following services would be provided to an eligible beneficiary by a health professional:
An update of the individual’s medical/family history.
An update of the list of current providers and suppliers that are regularly involved in providing medical care to the individual, as that list was developed for the first AWV providing PPPS.
Measurement of an individual’s weight (or waist circumference), BP, and other routine measurements as deemed appropriate, based on the individual’s medical/family history.
Detection of any cognitive impairment that the individual may have as defined in this section.
An update to the written screening schedule for the individual as that schedule is defined in this section, that was developed at the first AWV providing PPPS.
An update to the list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are under way for the individual, as that list was developed at the first AWV providing PPPS.
Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs.
Voluntary advance care planning (as defined in this section) upon agreement with the individual.
Any other element(s) determined by the Secretary through the NCD process.
Billing Requirements
Two new HCPCS codes, G0438 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit, (Short descriptor – Annual wellness first) and G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit, (Short descriptor – Annual wellness subseq) will be implemented January 1, 2011, through the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE).
Fall Prevention Clinics of America is a registered trademark of Orchard and Carlyle II, LLC company; an Illinois corporation.
