Training Top 125 Best Practice: Johns Hopkins Community Physicians’ Medicare Wellness Initiative
Johns Hopkins Community Physicians’ Medicare Wellness Initiative aims to increase the number of Medicare Annual Wellness Visits (AWVs) billed by 5 percent and to decrease the number of billing rejections due to incorrect billing codes being used for the AWVs by 25 percent. The targeted learners are in Johns Hopkins Community Physicians' (JHCP) Central Scheduling/Intake (CSI) department, which consists of 70 employees.
Since 2015, Central Scheduling/Intake has acted as a centralized point where Medicare patients eligible for AWVs could be identified. Staff members find and notate the eligibility of patients who are scheduled using data sent by Medicare through JHCP’s Real-Time Eligibility response system.
In late 2017, the organization discovered that the responses received from Medicare were populating in a different manner than they previously had. The entire process needed to be audited in order to come up with a new workflow. Meetings were held with the directors of Central Operations and Billing to legitimize the data used.
A job aid was developed detailing the new workflow and presented at individual team staff meetings in early 2018. The job aid also was e-mailed to site leadership to help their teams understand the processes and for them to utilize for the appointments that are scheduled by site staff.
For those who still displayed confusion on the new AWV identification process, one-on-one trainings were held with the Training Program manager.
In late 2018, a quality department was added to CSI to audit the correct completion of various aspects of JHCP’s scheduling and registration processes. It was found that a large number of Medicare appointments still were being made without Medicare Wellness codes and dates noted, or with incorrect visit codes noted. This became a focus for the Quality team and the Training Program manager as a result in early 2019. The process consists of the following components:
- Schedulers who have missing or incorrect notes are e-mailed and asked to add or correct their AWV note.
- Schedulers who omit or enter erroneous notes on a regular basis meet with their managers to discuss the need for improvement. Additional one-on-one training by the Training Program manager is offered if needed.
- For schedulers who understand the process but neglect to put the note in, the Training Program manager has developed a report schedulers can run on their computer to check for appointments that are missing the note. This gives them a quick and effective way to add the missed notes in prior to the appointment.
Multiple formats for learning were offered, including: paper, electronic, group and individual trainings, and gamification utilizing the Kahoot! game-based platform (staff members can answer multiple-choice questions using their cellphones during meetings to test their application of the material). Surveys were sent to the team asking them their preferred method of learning material and work to accommodate their preferences.
Short-term reinforcement includes auditing and feedback, plus additional training opportunities. For long-term reinforcement, JHCP acknowledges staff who demonstrate proficiency in the skill by offering recognition and allowing them to serve as peer trainers. The next step is to offer training to the staff and leadership in JHCP sites through “Lunch and Learn” Webinars so the understanding of the AWV coding processes is consistent throughout the organization.
- Some 95 percent of Central Scheduling staff report feeling more confident about entering correct Medicare Wellness notes today compared to a year ago.
- The Gallup Employee Engagement Survey question, “This year, I have had opportunities at work to learn and grow,” for the department improved from 3.69 in 2018 to 3.79 in 2019.
- The number of AWV claims billed increased by 9.8 percent from 2017 to 2018. And claims increased 11.4 percent in January-July 2019 as compared to January-July 2018.
- The percentage of AWV claims denied by Medicare decreased from 2.47 percent of claims submitted in 2017 to 0.63 percent in 2018 and 0.34 percent in the beginning of 2019. (The pure number of denials decreased by 71.9 percent from 2017 to 2018 alone and trended toward an additional 41.2 percent decrease from 2018 to 2019.)