The Medicare Annual Wellness Visit

 

A new benefit offered in the Affordable Care (Healthcare Reform) Act of 2010 for Medicare patients is an "Annual Wellness Visit," which every Medicare recipient can have once every 365 days.  This benefit has no coinsurance and is subject to no deductible, so it is a significant benefit for Medicare patients.  It has been described as "free."  Unfortunately, this has been promoted as an "Annual Physical Exam," but it really is not what most people expect from a "Physical Exam," and an actual examination of the patient or treatment of any known illness or symptoms is not included in this visit. 

What is included in the Annual Wellness Visit benefit?

Medicare requires that providers do the following  for the Annual Wellness Visit:

What is not included in the Annual Wellness Visit benefit?

The Annual Wellness Visit benefit is  intended for risk factor identification and preventive services planning.  It is not intended to  cover evaluation of  symptoms or medical problems a patient may have, and it is not intended for treatment of any disease a patient may have.  Examples of things not covered in the Annual Wellness Visit are:

Does this mean that the doctor can't take care of my medical problems when I come in for a Annual Wellness Visit?

No, nothing prevents the doctor from providing medical services or from treating illnesses on the same day as an Annual wellness visit.  However, physicians are expected to bill for these services separately, and these services are subject to the patient's  co-insurance and  annual deductible.  So, if a patient schedules an Annual Wellness Visit and needs a refill of medications or follow-up of a chronic problem or problems, the physician will submit a bill to Medicare with a service code of G0438 (for the first visit) or G0439 (for subsequent visits) and will also submit an evaluation and management service code of 99212 - 99215, depending on the time spent and complexity of the medical services offered.  If a patient needs a blood draw, EKG, or urinalysis due to any medical problems, these will be billed separately, too.   The services listed above as covered under the Annual Wellness Visit would be covered by Medicare without co-insurance or deductible, and the separate medical services would be subject to the co-insurance and deductible. 

From a practical standpoint, the Annual Wellness Visit is paid by Medicare at the same rate they pay for a 25 - 30 minute visit, and the patient is going to need to do quite a bit of pre-work before the visit for the physician to be able to meet the requirements to legitimately bill for the wellness visit.  It isn't very likely that any doctor could adequately take care of more than a few chronic problems as well as the wellness visit requirements in 50 minutes, which is the maximum amount of time my schedule allows for an individual visit. 

All patients will need to complete the pre-work for the exam before they are seen.  This can be accomplished from home before the visit by going to these two websites: Medical History Assessment and Health Assessment   If you are unable to accomplish this by yourself at home, and if you do not have family or friends who can help you with this, then you can come to our office a few days before your exam and do the pre-work on one of our office computers.  Please contact Eva to set up a time for this.  Due to our limited parking, you will need to come at a time when we do not have many other patients scheduled.  Be sure to bring the names and contact information of all of your health care providers and suppliers, since this is a required part of the information that must be gathered.

I am sorry that this is so complex, but I am not allowed to bill Medicare for this service without meeting all of their requirements.

 

Last revision: 12/24/2011