Comprehensive Visit Program

Member/Patient Engagement

Martin’s Point encourages our Generations Advantage members to receive both their Medicare Annual Wellness Visit and an annual physical exam each year with their primary care provider. While Original Medicare only covers the Annual Wellness Visit, Generations Advantage covers both at a $0 copay. These preventive visits serve as the primary platform for the annual assessment and documentation of each member’s health. We encourage our members to schedule these two services back-to-back in one longer appointment that we call a “Comprehensive Visit.” This affords primary care providers time to examine and develop health goals with their patients and to document the visit.

Why is this work important?

1. To promote the health of our members/your patients: Together, the Medicare Annual Wellness Visit and the annual physical exam promote:

  • Early detection and treatment of acute and chronic conditions
  • Development of care plans to close gaps in care and meet CMS-prescribed quality measures
  • Member access to free disease-management programs we offer

2. To comply with CMS Medicare Advantage program requirements to validate applicable diagnosis data each year: Generations Advantage and our network providers share responsibility for the documentation we are required to submit to CMS regarding the health status of our members. Our goal is to document existing diagnoses and identify diagnoses that may have been reported in error— accurately capturing the current health status of our members.

How does this work?

At the beginning of each year, Martin’s Point will send you a “Comprehensive Visit Form” for each of your qualifying Generations Advantage patients. (If you have not received a form for a qualifying patient, please contact us at CDI@martinspoint.org.)

The "Comprehensive Visit Form" will:

  • List each patient’s previously reported chronic conditions
  • Ask for verification or denial of the continued existence of each of those conditions
  • Ask for documentation of diagnoses of any other current conditions

To earn incentive payments:

1. Complete a “Comprehensive Visit” (both the Medicare Annual Wellness Visit and the annual physical exam) on or before December 31 of each year. Note: A Generations Advantage-participating primary care provider at your practice must render the exam. The exam should include a full system review and documentation of all current conditions, severities, and comorbidities.

For 2020
For the duration of 2020, the Comprehensive Visit Form can be completed during one of the CMS-acceptable visit types listed below. Telehealth visits are eligible for the program only when using an interactive audio and video telecommunications system that permits real-time interactive communication. Audio-only services are not eligible for the Comprehensive Visit Program. 

Visit Type CPT Codes
Eligible through Telehealth for Comprehensive Visit Program
Initial Preventive Physical Examination (IPPE) G0402 No
Federally Qualified Health Care Center (IPPE or AWV) G0468 Yes, in conjunction with the appropriate service code
Rural Health or Federally Qualified Health Care Center Telehealth Service G2025 Yes, in conjunction with the appropriate service code (After 7/1/2020)
New Patient Preventive Service 99381-99387 No
Established Patient Preventive Services 99391-99397 No
Annual Wellness Visit (AWV) G0438-G0439 Yes
Established Member Office Visits 99213-99215
Yes
New Member Office Visits 99202-99205 Yes
Office Consultations 99242-99245 Yes

*Some of these visit types may require member cost shares. 

2. Within 60 days of the completed form for the 2020 qualifying visits,” send Martin’s Point Health Care BOTH of the following items:

  • A Martin’s Point Health Care generated “Comprehensive Visit Form” that corresponds with a previously identified member sent to you in March 2020, completed, signed, and dated with updated diagnoses for ALL existing conditions
  • A copy of the completed encounter note from the patient’s EHR that provides supporting documentation, including assessment and plan, for each documented diagnosis

Please send this information via mail, fax, or secure email.

Mail:
Martin’s Point Health Care
ATTN: Clinical Documentation
PO Box 9746
Portland, ME 04104

Fax: (207) 828-7815

SECURE Email: CDI@martinspoint.org
(Please put “CVF” in subject of email and use a secure, encrypted email application to send.  If you do not have access to a secure email application, please send by mail or fax.)

For information about this program
Email: network.management@martinspoint.org
(207) 253-6147