Forms and Tools

Annual Wellness Visit - Template
This AWV was designed to fit all the ACO quality measures as well as all the metrics Medicare requires in an AWV. In the event the patient cannot complete a full AWV, please complete the Quality Measure Questionnaire to ensure that the QM's are met for the following GPRO audit.
Annual Wellness Visit .pdf
Adobe Acrobat document [301.4 KB]
Billing Codes - GPRO 2019
CPT Category II codes are used for tracking data collection for the purpose of Performance Measurements. These codes describe clinical components and are not associated with a billable amount, therefore, when used should be billed with a $0.01 charge amount. These codes are based on the QPP Medicare website under the Performance Category Requirements. For more information please contact your biller.
Billing Codes - GPRO (2019).pdf
Adobe Acrobat document [141.4 KB]
Quality Measure Questionnaire - 2019
This is NOT a substitute for the Annual Wellness Visit. This is strictly for ACMG’s Quality Measure audit.
Quality Measure Questionnaire - 2019.pdf
Adobe Acrobat document [96.1 KB]
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Copyright 2019 Accountable Care Medical Group of Florida, Inc. For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.