Medicare Wellness Exam Waste Of Time

Related Articles

The Medicare Annual Wellness Visit Shouldnt Be A Waste Of Time

Annual Wellness Visits (AWV) Video

The most common complaint from those age 65 and older is, Its a waste of my time and is just an excuse to bill Medicare. In other words, the Medicare patient doesnt understand the purpose of the Medicare Annual Wellness Visit nor do they know what one should expect.

Stronger Seniors Chair Exercise DVD Videos

When patients tell Serving Our Seniors about their Medicare Annual Wellness Visit, it appears all doctors do not conduct this free visit the same way. Some patients are disgruntled and complain all they do is fill out a questionnaire.

Others have said their doctor does an EKG and a physical. Still others are frustrated by not being allowed to discuss a new symptom at the time of their Annual Wellness Visit.

The most common complaint from those age 65 and older is, Its a waste of my time and is just an excuse to bill Medicare. In other words, the Medicare patient doesnt understand the purpose of the Medicare Annual Wellness Visit nor do they know what one should expect.

According to Kaiser Health News the Medicare Annual Wellness Visit is to give the doctor time to focus on preventing disease and disability by coming up with a personalized prevention plan for future medical issues based on the patients health and risk factors.

Answering a questionnaire is part of this visit. Your answers are used so you and your doctor can create this personalized prevention plan, but there is more to it than that.

The Medicare Annual Wellness Visit can also include:

Learn More About Medicare

Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.

| TTY 711, 24/7

Its an opportunity for you and your primary care doctor to touch base about preventable health diseases and keep you on the right track toward living a healthy and active lifestyle.

Annual Wellness Visits G0438 / G0439

The AWV is not an annual routine preventative physical exam. Those exams are much more comprehensive than the AWV. Many healthcare providers believe that the AWV is a routine physical exam and bill the G0438/G0439. That is incorrect.

In this case, it looks like the physician knew the differences in the exams and their requirements and limitation, and recommended a full physical, which was agreed to, so an AWV would not be appropriate to bill.

It sounds like the cost may have not been explained. It is technically not the responsibility of the medical practice to explain the cost of the full physical exams, as it is a Medicare non-covered service by statute, but it sure would be a good idea to provide the patient with the cost information first, instead of letting them find out later that they owe money .

The Annual Wellness Visit is comprised of only the following elements:

  • Medical and family history
  • List of current medical providers
  • Height, weight, BMI, BP and other appropriate routine measurements
  • Detection of cognitive impairment
  • Establish a written screening schedule for next 5-10 years
  • Establish list of risk factors
  • Provide advice and referrals to health education and preventative counseling services
  • Other elements as determined by the Secretary of Health and Human Services

Also, since the routine preventive exam is different than the AWV, Medicare allows both services to be performed at the same visit and billed with proper documentation.

What To Expect At Your Welcome To Medicare Visit

During the visit your provider will:

  • Record and evaluate your medical and family history, current health conditions and prescriptions.
  • Check your blood pressure, vision, weight and height to get a baseline for your care.
  • Make sure you are up-to-date with preventive screenings and services, such as cancer screenings and shots.
  • Order further tests, depending on your general health and medical history.

You do not pay a copayment for your Welcome to Medicare Visit. The Part B deductible does not apply to the cost of the visit either.

After the visit, your provider will give you a personalized prevention plan or checklist with the screenings and preventive services recommended for you. These services are not part of the Welcome Visit. You may have to pay a co-payment for the recommended services when you get them. Your Part B deductible may also apply.

Learn more about what to expect at your Medicare Wellness Visit.

Ways To Recruit And Enroll Your Patient Population


You now know how to overcome some of the most common patient barriers, but how do you communicate this to the patient?

There are a variety of methods providers can use to sell the benefits of Medicare programs, and recruit and enroll patients.

There are three primary methods to recruit patients for your AWV program.

  • In-Person
  • Outreach Campaign
  • Phone Call
  • To have the highest rate of success, try to introduce the program to the patient in-person during an in-office visit. During the visit, clinicians can thoroughly explain the benefits of the program and answer any questions the patient may have.

    Best practice is to have the provider/physician explain the program to the patient, as they usually carry the most trust and clout among patients.

    Some practices opt to do an outreach campaign, usually by sending a letter to the list of eligible patients explaining the value of the program and inviting them to participate.

    Set time aside to call all eligible patients, explain the program to them, and invite them to participate in the program.

    What Is And What Is Not Covered During Your Annual Wellness Visit Know The Difference

    At Tryon Medical Partners, your health is our top priority. We are an independent practice because it allows us to operate with greater transparency and a strong focus on the patient-doctor relationship.

    With this in mind, we want to clarify certain insurance and billing matters related to your care.

    Your annual wellness visit includes a check of your height, weight, bloodwork and vital signs. You and your doctor will discuss any changes to your health, and will work together to create a personal health plan for the year ahead.

    Please note, there are certain areas that may not be covered by your insurance provider, Medicare or a Medicare Managed Care plan. This may require paying a copay or deductible during your annual wellness visit.

    Understanding what is covered and what is not may help you determine ahead of time which topics you would like to discuss with your doctor.

    These areas are not covered by your insurance during your annual wellness visit:

    Of course, your doctor or care provider will talk with you about any topics you would like during your annual wellness visit. However, if you have a question about what may be covered and what is not, please do not hesitate to ask at the beginning of your visit.

    In advance of your appointment, we encourage you to consult with your insurance provider if you have questions or concerns about your coverage.

    Understanding Why Medicare Does Not Pay For Annual Physical Exams

    Now that we’ve summarized the different services provided during these annual exams and visits, we can examine why Medicare only covers annual wellness visits and not annual physical exams.

    The reason becomes more apparent when we simplify the differences between an annual physical exam and an annual wellness visit. As the KHN article referenced earlier states, “An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure.” The UNC School of Medicine notes, “Medicare wellness visits are designed to improve your overall health care by providing a more detailed look at your health risks based on family history and health behaviors and more.”

    Think of the annual physical exam as more of a “hands-on” experience, whereas the annual wellness visit takes a “hands-off” approach to evaluation. It would seem that when the federal government was debating what to cover within traditional Medicare, the decision was to cover the broader look at a beneficiary’s health. In discussing the annual wellness visits, AARP states, “The visit provides a snapshot of your current health as a baseline for future yearly visits, and is intended as a preventive service a way of catching potentially serious health issues early.”

    Common Barriers For Providers And How To Overcome Them

    Below, well lay out some of the most common barriers from the physicians perspective.

    After learning about these barriers and how to overcome them, youll then be well equipped to ease any concerns from patients and showcase the value of AWVs for them.

  • Time Constraints
  • Complex Requirements
  • Making The Care Management Paradigm Shift
  • Many healthcare providers are pressed for time. Asking them to dedicate between 30 minutes and an hour of their time to complete a preventative examination can understandably be met with disinterest.

    This is where quality care management software can be critical to a programs success.

    The Centers for Medicare and Medicaid Services encourages utilization of Health Risk Assessment guidelines using an automated process, something that good care management software can do.

    For example, a quality AWV solution greatly reduces the clinicians and providers time spent on AWVs through guided-interviews, automating the HRA and AWV process.

    Another workaround to the time constraint issue is the fact that AWVs dont need to be completed by the physician. If you go this route, the physician simply has to sign off on the AWV.

    Using another member of your care team to administer AWVs can free up the physician to handle more pressing matters.

    Health care professionals who may administer and bill AWV include:

    Many providers consider AWVs to have complex requirements, in addition to being time-consuming.

    Does Medicare Require A Wellness Exam

    What to expect at your Medicare Annual Wellness Visit

    Medicare does not require a wellness exam however, its still important to take advantage of this important benefit. Thats because the wellness exam gives you an opportunity to get personalized health advice.

    You can talk about any healthcare concerns you may have, ask questions about your medications, talk about changes to your diet or exercise routine and more.

    Common Barriers For Patients And How To Overcome Them

    Now that you understand the myths and misconceptions that prevent many providers from taking advantage of the benefits AWVs provide, you now need to be able to sell your patients on this valuable program.

    Below well cover the three most common barriers for patients and how you can eliminate these concerns from the minds of your patients.

  • Lack of Knowledge
  • Not Understanding the Purpose of AWVs
  • More Complex Health Needs/Concerns
  • As we stated at the outset of this article, the vast majority of eligible patients are not getting AWVs.

    One main reason for this is that patients simply arent aware of this service. There are three types of AWVs, which can add confusion.

    Within the first 12 months of Medicare Part B enrollment, patients are eligible to receive the Welcome to Medicare/Initial Preventive Physical Examination .

    This is a once in a lifetime benefit patients can choose to receive when they are new to Medicare.

    If 12 months have passed and the patient has not used this benefit, they are no longer eligible to receive it. Instead, they would be eligible for an Initial Annual Wellness visit.

    Once you’ve been on Medicare Part B for a year, you’re eligible for this AWV.

    Moving forward, the Subsequent Annual Wellness Visit is offered to Medicare patients every year, but only after they have completed an Initial Annual Wellness Visit.

    Patients are eligible for this visit 11 full calendar months after their Initial Annual Wellness Visit.

    Why We Wont Stop Providing Routine Wellness Visits

    Yet early research showed that it had a rocky start. At first, many people didnt know they were eligible, and local adoption has had mixed results. My colleagues and I wondered how these visits were playing out across the country. Using national Medicare billing data, we looked at the adoption of the annual wellness visit from its start in 2011 through 2014, the last year for which data were available. Our results appear in the of the Journal of the American Medical Association.

    We discovered that only 8 percent of Americans eligible for the annual wellness visit had one in its first year of operation that rose to 16 percent by 2014. We saw signs that these rates were driven more by doctors or medical practices offering the visits than by patients asking for them. For example, the chance of getting a wellness visit varied tremendously based on geography from 3 percent in San Angelo, Texas, to 34 percent in Appleton, Wis. Patients who belonged to an accountable care organization a group of clinicians who work together to provide coordinated care for Medicare patients were more likely to get the visits. Nearly half of all annual wellness visits were performed by just 10 percent of the doctors who provided them. We think, and are now trying to confirm, that the doctors and practices that do more of these elaborate visits have had to hire a dedicated nurse or invest in special work processes to make them happen.

    Recruitment Tips And Strategies

    Feel free to use this list of some popular recruitment tips and strategies for AWVs:

    • Avoid a sales pitch style or tone when trying to recruit patients
    • Listen to the patients needs and identify the benefits of AWVs that address their needs
    • Since AWVs play an important role in the patient-centered care model, prioritize the focus on the patient rather than the clinical importance of the visit
    • Highlight AWVs allowing patients to spend more time with the doctor to discuss their health more in-depth
    • If patient barriers like transportation, time, etc. exist, brainstorm potential solutions with the patient
    • If a physician cannot make the pitch, emphasize the physicians desire to enroll the patient as it will help the doctor provide the best care possible

    Initial Preventive Physical Exam G0402

    Team Based Care

    The Initial Preventive Physical Exam G0402 could have been provided and billed out by your provider during the first 12 months of receiving Medicare. If you saw the physician before 11/16/2011, this Medicare exam would have been covered.

    There were also additional once-in-a-lifetime benefits that could also have been provided to you in conjunction with the IPPE , and the Pneumococcal Vaccine).

    However, if you were not seen by a provider or if your physician did not actually provide these services, then, unfortunately, you missed out on these benefits, as they must be done within the first year of Medicare eligibility. It is the patients responsibility to schedule this exam, however, I suggest that it is good customer service for the medical office to call the patient to schedule an appointment.

    The components of an IPPE are:

    • Review of the beneficiarys medical and social history
    • Review of the beneficiarys potential risk factors for depression and other mood disorders
    • Review of the beneficiarys functional ability and level of safety
    • An examination
    • Education, counseling, and referral based on the previous five components
    • Education, counseling, and referral for other preventive services

    Medicare provides a quick reference information sheet on the IPPE at

    Invest In Preventive Services Technology

    Investing in the right technology can help your practice reduce the time spent on preventive services, such as the annual wellness exam, while increasing reimbursements. One such technology is Prevounce. This customizable, holistic wellness platform improves eligibility verification, patient outreach and intake, billing and coding, documentation requirements, compliance , and much more. Schedule a demo today!

    Whats The Difference Between A Medicare Annual Wellness Exam And The Initial Preventive Physical Exam

    The Initial Preventive Physical Exam is a one-time exam also focused on preventable health diseases that occurs within the first 12 months of your Medicare Part B coverage.

    Many of the services you receive during the Welcome to Medicare visit are the same as ones you get during the annual wellness exam , and like the wellness exam, there is no cost to you if your doctor accepts Medicare.

    Be Transparent About Additional Services

    Whether you perform an annual wellness exam, annual physical exam, or IPPE, you may determine that it is worthwhile to provide treatments or additional preventative services not necessarily covered under these routine exams. Before proceeding with these treatments or services, explain to patients why you recommend them, and what they are likely to cost patients. Doing so will help avoid the problems previously noted.

    What Is A Medicare Annual Wellness Visit

    Medicare Coverage and Payment of Cognitive Assessment & Care Plan Services

    If you choose standard Medicare coverage, you can opt to have an Annual Wellness Visit with the purpose of creating a personalized prevention plan. In addition, topics such as advance care planning are discussed. When making your appointment, let your doctors office know this is your Annual Wellness Visit. Like the Welcome to Medicarevisit, it is not a head-to-toe physical exam. Your AWV is covered if you have been enrolled in standard Medicare coverage for more than 12 months and you have not received another AWV in 12 months. Over time, your personalized prevention plan will be updated based on our current health and risk factors.

    Medicare Annual Wellness Visit Required By Law

    Trying to determine if medicare patients have the right to refuse the annual wellness visit or is it mandated by law?

    This isn’t a laughing matter to me. My healthcare provider sold out to a big St. Louis for profit organization. Now they are taking steps to increase profit, and one of those steps is to require a Medicare annual wellness visit with each routine physical. For 3 or 4 years they honored my request that I didn’t want or need the wellness visit. Now they have decided that I must take it or else….

    My last physical 1st the nurse told me my insurance might not pay for my physical if I didn’t take the wellness visit. I called my insurance they didn’t even know what she was talking about.

    I refused, my Doctor told me Medicare WANTED them to give the exam. I called Medicare, they said they didn’t want or require us to do anything, not even go to the Doctor.

    Since they aren’t allowed to do a Physical and wellness check on the same visit, they charge you for a co-pay and your insurance provider for an additional office visit, which you don’t get. The Wellness check only consists of a questionnaire asking if you needed help recently to do daily tasks. My Doctor sees me twice a year and KNOWS my physical condition .According to Medicare any charges to medicare that you don’t want or need is billing fraud. I believe medicare fraud is so rampant it s impossible for Medicare to address the issue.

    Popular Articles