Annual Wellness Visits FAQ
An Annual Wellness Visit is a detailed assessment of a patient’s current health and risk factors. Through a question-based assessment, patients come into the office once a year to identify at-risk areas.
These visits focus on prevention rather than intervention and are followed by counseling to help patients reduce their health risk factors.
PRACTICE & PATIENTS
Why should I offer Annual Wellness Visits?
Medicare’s Annual Wellness Visits (AWV) are a great way for physicians and practices to help their patients have a more keen sense of their health and risk factors for certain potential illnesses or diseases. With the move towards value-based care, AWV helps providers to expand their care services and quality of care. The Personalized Prevention Plan Services (PPPS) conducted in an AWV promote prevention rather than intervention, contributing to better health outcomes and improving patient engagement.
Is an Annual Wellness Visit similar to annual physical exams?
No. Annual Wellness Visits are a question-based assessment and do not involve a head-to-toe examination of the patient.
Who is eligible for an Annual Wellness Visit?
Annual Wellness Visits are open to all patients with Medicare. A patient is eligible for an Annual Wellness Visit if he or she has had Medicare Part B insurance for more than 12 months and has not received an initial preventive physical exam or AWV in the last 12 months.
What and which Medicare covers this service?
Medicare Part B insurance and most Medicare Advantage (Part C) plans cover Annual Wellness Visits. This service is available at no cost to the patient; Medicare covers it 100%.
How is this program connected to the patient’s regular doctor?
Annual Wellness Visits are performed in the doctor’s office and all follow-ups are completed by a patient’s usual physician.
What will the duration of the visit be?
Annual Wellness Visits typically last 30 minutes, depending on patient questions and nurse concerns.
What can patients expect during their Annual Wellness Visit?
The visit is composed of questions to assess the patient’s current state of health, including any symptoms or conditions they are managing, and to determine what type of follow-up care and preventive health visits (such as colonoscopies, mammograms, prostate exams, bone density scans, immunizations, and blood tests) they might need throughout the year in order to ensure that they are receiving the best possible care. Patients should expect to leave with instructions on how to reduce potential risks to their health as well as a calendar of which preventive health services are appropriate for them and when they will need to receive them.
Are the visits mandatory for patients?
Annual Wellness Visits are not mandatory, however Medicare highly recommends them for all Medicare patients.
How do we sign up patients?
Patients are first educated on the program, schedule an appointment and then take part in their AWV.
Do patients need to sign a consent form for their Annual Wellness Visit?
This service requires no consent form.
How does this program benefit the patient?
Most visits are focused on an existing problem or issue, where the provider is focused on completing that comprehensive exam. This primarily question-based assessment is specifically focused around determining if a patient’s current treatment plan is fully addressing their needs, if there are any symptoms or concerns they are experiencing that have not been addressed, and making sure that we are properly surveying them to ensure that any potential new concerns are addressed early. Many patients feel that they can visit the doctor several times and still have things fall through the cracks. This is an opportunity to pause and assess that everything is being fully managed, and to bring issues to their doctor’s attention that may require further follow-up.
Who can provide and bill Medicare for an Annual Wellness Visit?
An Annual Wellness Visit can be billed and provided by physicians, physician assistants, nurse practitioners, clinical nurse specialist, health educators, registered dietitians, nutrition professionals, or other licensed practitioners.
What does my practice need to do in order to complete an AWV?
- Inform Conduct a Health Risk Assessment (HRA)
- Note current health providers
- Establish patient’s medical and family health history
- Note patient’s risk for depression based on current or past experiences related to depression or any mood disorders.
- Use appropriate screenings to determine patient’s level of safety
- Conduct a General Health Assessment
Is there a cancellation fee or policy for patients who do not show up to their AWV?
There is no cancellation fee on our end at this time, however the patient may be subject to the cancellation policy of their usual doctor’s office.
Can multiple providers file for AWV for the same patient?
Annual Wellness Visits can only be billed once in a twelve-month period for every patient.
How do I as a physician or practice bill for an AWV?
Unlike regular physical exams, Medicare pays 100% of the visit, therefore the patient does not need to be billed for their visit. Annual Wellness Visits are a great source of annual, recurring revenue from both eligible Medicare patients in the beginning, and on an annual basis for all subsequent visits.
If I hire someone can I do it myself?
Yes, but many providers find it is more advantageous economically to partner with us. We have found that many practices don’t have the time or the money to take on the entire program alone. Providing AWV requires multiple screening exams, is time consuming and requires the understanding of regulations and audits.
Is it legal to outsource the service?
Absolutely. The physician’s practice reviews all of the notes and we act as an extension of your practice.
What level of qualification does the person they are seeing have?
To ensure the utmost level of quality care for your patients, Wellbox now only hires Registered Nurses to conduct Annual Wellness Visits.
Why are patients seeing a nurse and not their usual doctor during an AWV?
The focus of this visit is to gather information about how they are doing, and to determine what types of tests and visits with their doctor they will need throughout the year to make sure that we are both managing current conditions and surveying for potential risk factors.
Will we be provided contact information for the RNs if we need to reach them for any reason?
The nurses are paid an hourly, contracted rate and should not be contacted by the appointment team directly. All inquiries should be directed through the clinical operations team in Jacksonville, Florida.
How do you document?
Wellbox takes care of educating your patients on the Annual Wellness Visit services by reaching out to them, explaining the program, scheduling a visit in your office with one of our Registered Nurses, conducting the visit and documenting directly in your EHR.
What codes are used in order to file claims?
The Initial Preventive Physical Examination (IPPE) code is G0402. For the first Annual Wellness Visit, the code used is G0438, which includes the Personalized Prevention Plan of Services (PPPS). For all subsequent AWV visits, the code used is G0439, which also includes the PPPS.
How much is a doctor’s total reimbursement?
The average reimbursement for an initial Annual Wellness Visit is $172 per patient under the code AWV G0438. For all subsequent visits, using code AWV G0439, the average reimbursement per patient is $111.
How do I bill an Annual Wellness Visit if I outsource?
Wellbox provides the practice billing staff with a complete list to submit to Medicare for reimbursement.
Are there any hidden fees?
Can a provider bill for other services during the same month as AWV?
If a provider furnishing AWV performs any other services for the beneficiary (such as CCM or any other), the provider cannot bill for the different services on the same day, but can bill Medicare for all of these services in the same month.
How will AWV help with MACRA/MIPS?
Quality Measures: AWV services meet 18 measures in 4 out of the 6 domains, including 6 HIGH priority measures.
Clinical Practice Improvement Activities: AWV services also meet 3 measures across 2 subcategories for CPIAs.