4 benefits of Medicare Annual Wellness Visits

Daniel Bluestein, MD, CMD, is a primary care physician and an expert on the revenue potential from the Medicare Annual Wellness Visit (AWV), added as a benefit of the Affordable Care Act in 2011. 

Here’s what he says you should know to maximize this specific visit for your patient and for your practice.

1. It’s different from and better than a “regular” physical.

The AWV is an opportunity to really coordinate care, he says. It’s a time to talk proactively about the “whole” patient, especially their medical and family history and current health conditions, along with medications and supplements. The provider can also obtain specific vitals, such as height, weight, body mass index, blood pressure and vision, and discuss recommended screenings and vaccinations.

2. It pays the practice back.

Bluestein says that AWV can be reimbursed over and above the standard office visit Current Procedural Terminology (CPT) codes, and has some other perks as well.

“If necessary, providers can still add a significant, separately identifiable evaluation and management service code from the same physician on the same day of the procedure or other service if applicable,” Bluestein says. 

The wellness visit is also a golden opportunity to discuss the extremely important topic of advanced care planning and for referrals to community-based health resources if applicable. The CPT code 99497 for the first 30 minutes of advanced care planning is $86 and for each additional half-hour is $75. 

Also, value-based reimbursement programs include calls for documenting quality improvement and the conduct of practice improvement projects. The wellness visit is a vehicle for meeting those stipulations, Bluestein says.

3. It’s an investment in support success.

Bluestein says internal polling at his office found that most patients had never heard of a AWV, but wanted one when they did. Historically, the uptake on patients taking advantage of AWVs is quite low. A 2014 CMS report shows that a mere 14.5% of eligible Part B fee-for-service beneficiaries took advantage of the service.

“Patients have to have buy-in,” says Bluestein, “and they need to understand this visit isn’t a physical and this isn’t the time to come in about a sore knee.”

Remind patients they can have an initial AWV in their first year of Part B eligibility, and then an ongoing, subsequent AWV starting in their second year of eligibility, Bluestein suggests. The visit itself is 100% covered by Medicare, though there may be other charges for immunizations, lab draws, etc.

“It’s also a way to further engage patients and encourage their loyalty,” he says. “Patients generally like these visits. The strongest predictor of getting further wellness visits was having an initial one in the first place.”

4. It provides quality time with patients.

This is the clinician’s chance to spend quality time, usually 40 minutes to 60 minutes, with a patient. The conversation may yield an open exchange of information, and the patient may disclose other problems that require follow-up care-for which the practice really can bill. Remember, too, that the initial visit and follow-ups can be accomplished by the physician, or by a physician assistant, nurse practitioner or other medical professional or team directly supervised by the physician. 

“Remember that your interventions with the annual wellness visit may reduce the likelihood or reduce the duration of more serious problems later for a patient,” Bluestein says.