8 FAQs About Medicare Annual Wellness Visits

With growing emphasis placed on Value-Based Care models in the US healthcare system, preventive and holistic approaches to treatment will only continue to gain prominence. One vital component of Value-Based Care is the Annual Wellness Visit, which serves to improve quality of life for Medicare patients 65 years and older, identify eligibility for Chronic Care Management services, and reduce overall healthcare costs. Keep reading for answers to some frequently asked questions about Medicare Annual Wellness Visits.

1. What is a Medicare Annual Wellness Visit?

The purpose of an Annual Wellness Visit (AWV) is to offer preventive care planning to those 65 years and older who are covered by Medicare. The visit involves a detailed discussion and analysis of the patient’s health status and risk factors with the goal of improving quality of life with age.

2. Is an AWV the Same as an Annual Physical?

No. AWVs and annual physicals are often mistaken for each other, but there are some important distinctions to note. An annual physical typically serves the purpose of treating any current or pre-existing health conditions, running diagnostic tests, and performing a physical examination.

An AWV, on the other hand, does not involve a detailed physical examination and instead focuses solely on preventive care and wellness planning. The provider can, however, refer the patient to other services during the AWV if deemed necessary.

3. How Are AWVs and Chronic Care Management Connected?

AWVs and Chronic Care Management (CCM) often work in tandem for Medicare patients who live with two or more chronic conditions (such as arthritis or diabetes) that are expected to last at least one year (or until death). The information collected during an AWV allows the provider to determine if the patient qualifies for CCM services, which include continuous care between office visits, coordination with specialists, and medication management. Patients who utilize both AWVs and CCM services tend to experience better health outcomes and closer relationships with their care teams.

4. What Are the Billing Components of an AWV?

Health Risk Assessment

The Health Risk Assessment (HRA) is meant for extracting information about the patient’s physical activity levels, diet, tobacco and alcohol use, and emotional health. It also identifies risks such as falls, depression, or cognitive decline, which helps the provider recommend appropriate preventive care and any necessary interventions.

Review of Medical and Family History

Reviewing a patient’s medical and family history informs the provider of current conditions, medications, and any past procedures. It also brings to light any inherited risks, ensuring that treatments align with the patient’s evolving health needs.

Measurements

Recording measurements such as height, weight, BMI, and blood pressure monitors health trends over time and helps detect certain issues preemptively, allowing for timely interventions and lifestyle adjustment recommendations.

Cognitive and Functional Assessment

The cognitive and functional assessment screens for memory loss, confusion, and mobility limitations. Identifying cognitive decline or fall risks early on allows the provider to recommend appropriate measures to promote safety and independence for long-term well-being.

Depression and Risk Screening

Depression and risk screening is meant for collecting data to identify any issues with emotional health, including anxiety or social isolation. Proactively addressing mental health issues connects patients with necessary resources, leading to improved overall well-being and decreasing the risk of future health complications.

Personalized Prevention Plan

The provider can recommend any necessary screenings, vaccinations, or health advice tailored to the patient’s specific needs and risk factors with the goal of improving long-term health.

Advance Care Planning (Optional)

Advance Care Planning (ACP) involves a discussion of future healthcare preferences, such as end-of-life care, ensuring that the patient’s wishes are documented and providing clarity for families and healthcare providers in critical moments.

5. What is Not Covered by a Medicare AWV?

The following is a list of services that are not covered by Medicare and may incur additional costs if performed during an AWV:

• Detailed physical exam

• Vaccinations

• Medication management

• Real-time treatment of illnesses

• Diagnostic tests

6. Who Qualifies for an AWV and How Much Does it Cost?

Medicare beneficiaries who have been covered under Medicare Part B (Medical Insurance) for more than 12 months qualify for a free AWV with an in-network provider each year. The provider should verify that the patient is eligible for reimbursement using the HIPAA Eligibility Transaction System (HETS) database.

7. Do Any Restrictions Apply?

An initial AWV cannot take place within 12 months of the patient’s Medicare Part B enrollment. Those who have been enrolled in Medicare for less than a year, however, are eligible for the Welcome to Medicare visit.

8. Who Can Perform and Bill for an AWV?

Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and medical professionals working under a physician’s direct supervision can perform and bill for AWVs.

Improving Patient Outcomes and Reducing Healthcare Costs

By conducting regular Annual Wellness Visits for eligible Medicare patients, healthcare providers can more accurately anticipate and prevent patient health issues, leading to improved quality of life and a reduction in overall healthcare spending.

Taking advantage of a state-of-the-art, AI-powered care management platform can make providers’ lives easier by streamlining workflows and easily identifying which patients are eligible for Medicare Annual Wellness Visits.

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