Health Care Quality Assessment Form Provider Incentive
Santa Clara Family Health Plan (SCFHP) is encouraging primary care providers (PCP) to assess their Cal MediConnect member’s medical conditions during their patient’s Medicare annual wellness visit.
PCPs who perform an annual wellness visit and complete the Health Care Quality Assessment Form (HCQAF) are eligible to receive $150.00 payment, per Cal MediConnect member.
To request your organization or doctor office’s HCQAF contact Monday Reynolds at firstname.lastname@example.org or Provider Network Operations at ProviderServices@scfhp.com. You can also call us at 1-408-874-1788, Monday through Friday, 8:30 a.m. to 5:00 p.m.
Annual wellness visit frequently asked questions
During a Medicare annual wellness visit providers will develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA). An annual wellness visit also includes: medical and family history, list of current providers, biometrics, cognitive function, potential risk factors for depression, functional ability and level of safety, written screening schedule for the next 5-10 years, list of risk factors and conditions for interventions, health advice and referrals, and voluntary advance planning.
The Medicare annual wellness visit is a covered benefit once every 12-months. Medicare does not cover routine physicals. For information on Medicare wellness visits see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html.
Medicare Part B covers annual wellness visits if performed by a:
- Physician (MD or OD)
- Qualified Non-Physician Practitioner (PA, NP, CCNS)
Medical professional directly supervised by a physician
Use these HCPCS codes to file annual wellness visit claims:
- G0438 initial visit
- G0439 subsequent visit
- If an E/M service is needed, e.g., 99213, amend modifier -25 to the CPT code
You can only bill G0438 or G0439 once in a 12-month period. HCPCS codes G0438 or G0439 must not be billed within 12-months of a Medicare initial preventive physical examination (IPPE, G0402). To learn more about Medicare IPPE visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
A Health Risk Assessment (HRA) is a questionnaire that involves collecting health-related information from Medicare members. Providers use this information to evaluate the health status or health risk of their patient. The HRA is also a required component of the annual wellness visit. If your practice does not have a compliant HRA form, you can download SCFHP's: (HRA form coming soon)
Visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html to see if your practice’s form is CMS compliant.
Note: to save time SCFHP recommends mailing the HRA to the patient so it can be completed before the visit. However, the HRA can be completed during the visit.
Medical record documentation is used to determine support for medical necessity, and for diagnoses that were submitted on claims. Therefore, documentation should be an accurate description of your patient’s health status, including: diagnosis, co-morbidities, severity, progression, and treatment. See the documentation and coding newsletters at https://www.scfhp.com/for-providers/provider-resources/tip-sheets/ for coding tips as outlined by ICD-10-CM Official Guidelines for Coding and Reporting and the Centers for Medicare and Medicaid Services.
HCQAF frequently asked questions
The HCQAF encourages providers to schedule an annual wellness visit and document vital information from the patient. The HCQAF activity requires a health risk assessment questionnaire, assessment of all active medical conditions, and a personalized care plan. The Centers for Medicare & Medicaid Services (CMS) expects providers to assess their patient’s active, ongoing and chronic conditions at least once per calendar year. This includes comorbidities and conditions that frequently do not get reported on claims e.g., transplant status, amputations, old MIs, and artificial openings.
The Diagnosis Code History, and Diagnostic Category History, might not have pre-populated diagnosis codes or descriptions. There are multiple reasons why there may be no pre-populated data. For example, no chronic conditions have been submitted on a claim before or this may be the patient’s first visit. Treat these forms as you would if they contained diagnosis codes or descriptions. Schedule an annual wellness visit with these patients and complete the remaining requirements to be eligible for the additional payment.
These diagnosis codes come from SCFHPs claim history. Assess each Diagnosis Code and mark the current status of the condition as either active, resolved or non-applicable (N/A). Document all active conditions in the note to the highest level of severity.
These diagnostic categories did not come from claims history. Therefore, we do not have specific ICD-10 codes. Assess each Diagnostic Category and mark the current status of the condition as either active, resolved or non- applicable (N/A). Document all active conditions in the note.
If any of the HEDIS measures listed in the Gaps in Care section apply to your patient, mark the activities that have been performed, reviewed, referred and or ordered
To be eligible for the $150.00 additional payment visits must be performed either face-to-face or via two-way interactive audio and video.
Before faxing the assessment form, use the HCQAF Checklist that was included with your form. The checklist will help determine if the assessment form is complete and will be eligible for additional payment.
Fax the completed assessment form, Health risk assessment and clinic note for each patient to
Attn: Monday Reynolds, HCQAF
A $150.00 payment will be offered for completed assessment forms and medical record documentation per Cal MediConnect member.
Once the submitted documentation has been confirmed as complete and meets CMS standards, SCFHP will make quarterly payments to the Tax Identification Number associated with the rendering/submitting physician. This payment will be made separately and not part of the claims remittance.