What To Expect From The Annual Wellness Visit
During or before your visit, your physician will ask you to complete a Health Risk Assessment. The assessment is basically a questionnaire that asks about your health status, injury risks, and urgent health needs.
Your first annual wellness visit will be the most comprehensive. In addition to completing the Health Risk Assessment, you can expect your physician to:
- Record your height, weight, blood pressure, other basic measurements
- Assess your functional ability and safety risks
- Ask about your medical and family history
- Document all of your medications
- Screen for cognitive impairment and depression
Post Visit Follow-Ups
Your physician will use all of this information to update your preventive health plan and a screening schedule or preventive measures checklist, and provide applicable health advice. They may also refer you to necessary health education or preventive counseling services to reduce any risk factors, regarding things like weight loss, fall prevention, smoking cessation, or physical activity.
What Gets Updated Each Year
Although subsequent wellness visits may not be as comprehensive as the first, your doctor should still check your major health markers like weight, blood pressure, and cognitive function, and will update your information and health plan accordingly. For each Annual Wellness Visit, you should come prepared with your medical and family history, immunization records, and a list of your current prescriptions.
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 to Medicare” 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.
Annual Wellness Visits: Not Required But Worth It
Medicare recipients are eligible for an annual wellness visit once theyve had Medicare Part B for 12 months or more. According to Medicare.gov, the goal of the visit is to develop or update a personalized prevention plan, designed to help prevent disease and disability based on your current health and risk factors.
Patients complete a health risk assessment, and providers typically complete a medical and family history review as well as take patients height, weight, blood pressure, and other routine measurements. Providers may also discuss recommended preventative services and screenings.
In an opinion piece for STAT, Does Medicares free annual wellness visit do any good?, Ishani Ganguili, MD, an instructor of medicine at Harvard Medicine School and primary care physician at Brigham and Womens Hospital, questions the utility of the annual wellness visits.
Dr. Ganguili says that while the exam requires clinicians to run through a lengthy list of tasks like screening for dementia and depression, discussing care preferences at the end of life, and asking patients if they can cook and clean independently. . .Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
DUMMYTEXT
Recommended Reading: Are Hearing Aids Covered By Medicare Australia
What Does It Include
The doctor collects comprehensive information about the patient and may do some of the following things:
Review Health Risk Assessment
The primary aim of the Medicare Wellness Visit is to target possible health issues that a patient may have. Therefore, the professionals will collect information about your health. You might be asked for information about aches, discomfort, and other issues you might experience due to a health problem. The doctor creates a comprehensive risk assessment and determines the possible diseases you might have.
Assess Family Medical History
Family medical history plays an essential role in diagnosing medical conditions you may have in the future. Therefore, the Medicare Wellness Visit collects family information on your maternal and paternal side to determine your chances of developing specific health problems.
Record Current Prescriptions and Providers
Current medications might have side effects on your future health conditions. Thus, the experts at Medicare Wellness Visits might document your existing medical providers and prescriptions.
Measure and Document Health Metrics
Several basic health metrics such as blood pressure, height, and weight can be significant indicators of possible health problems. Therefore, the doctors will assess and measure them and add them to your report until your next Medicare visit.
Check for Signs of Memory Problems
Document Health Risk Factors and Treatment Options
Provide Personalized Health Advice
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.
You May Like: What Is A Medicare Wellness Checkup
Does Medicare Cover Physical Exams
Unfortunately, Medicare does not cover physical exams performed on individuals. The test and screenings your doctors recommend after a physical exam are separate services, and these tests vary according to specific Medicare plans.
Or, individuals may not worry about the costs if they have additional health insurance plans. However, you need to discuss the exact details with the insurance provider for it.
However, Medicare Part B also covers a Welcome to Medicare Visit.
What Is A Medicare Wellness Visit
The Medicare wellness visit is a covered visit that allows your health care provider to dedicate time for a health risk assessment and prevention/screening strategies. During this visit, your health care provider will go over your health risks, prevention and screenings only giving your provider the time needed to make sure all of your immunizations, cancer screenings and personal screenings based on risk are discussed and scheduled.
Your physician will conduct a health risk assessment and create a five to 10-year personalized health plan that promotes health and prevents disease. The visits give you the opportunity to ask questions and get in-depth information.
The Medicare wellness visit is not a comprehensive physical exam. But if you have a certain Medicare Advantage Plan, you can schedule a physical exam and a wellness visit for the same appointment with your provider
Don’t Miss: How To Determine Medicare Eligibility
Update The Patient’s List Of Risk Factors
This part of the Medicare wellness visit will help identify which preventive services and screenings the patient may need. The list should include mental health conditions, substance use disorders , and any cognitive concerns or impairments. For any identified risk factors, treatment recommendations should be provided to the patient and documented in the visit notes.
What Is The Annual Wellness Visit
The Annual Wellness Visit is a yearly checkup that Medicare covers for most enrollees. The visit is intended to help people with Medicare maintain good health by catching signs of disease early on and taking a preventive approach to healthcare.
The Annual Wellness Visit, which was created as part of the Affordable Care Act in 2010, is a recent addition to your Medicare benefits. It was introduced by the Centers for Medicare & Medicaid Services in 2011 to help address health risks faced by older populations and encourage Medicare recipients to take charge of their health.
Research shows that people with Medicare who take advantage of the AWV are more likely to receive important preventive care services like vaccines and cancer screenings than those who skip out on the visit.1
Actionable Advice
The purpose of the Medicare Annual Wellness Visit is to establish and maintain a personal preventive care plan. Upon enrolling in Medicare, everyone is entitled to a Welcome to Medicare visit, during which an initial preventive care plan will be written. The ensuing Annual Wellness Visit appointments are meant to update your existing preventive care plan and make any necessary changes.
The AWV is also a great way for your doctor to stay up-to-date on your health. Its an opportunity for him or her to offer actionable advice that helps you maintain or improve your health for the coming year.
You May Like: What’s Part B Medicare
/7 What Do I Need To Bring To My Medicare Wellness Visit
To make the most of your Medicare wellness visit, its a good idea to come prepared. First, youll need to bring your Medicare card. Youll also need to bring a list of your current medications, as well as any allergies you have. Its also helpful to bring a list of your current health concerns. Finally, make sure to bring a photo ID, just in case.
Get my Yoga freebies!
/7 Is A Medicare Wellness Visit Covered By Medicare
Yes, a Medicare wellness visit is covered by Medicare. This visit is an important part of staying healthy and preventing illness, and it is covered under Medicare Part B. During this visit, your doctor will create or update a personalized prevention plan for you, based on your age, health, and family history. The plan will help you stay healthy and prevent illness in the future.
Also Check: When Can You Get Medicare At What Age
Evaluate And Document The Patient’s Risk Factors For Depression And Any Past Experiences With Depression Or Other Mood Disorders
Discussions about mental health are never easy, but seniors have some of the highest incidences of depression, so this component should not be overlooked. The PHQ-9 is a great tool for this part of the evaluation. The PHQ-9 can be filled out by the patient or patient representative prior to the appointment and then reviewed and discussed during the visit.
/7 What Are The Benefits Of A Medicare Wellness Visit
A Medicare wellness visit is an important yearly appointment with your doctor. The visit is an opportunity for you and your doctor to discuss your health and any changes or concerns you may have. The visit also gives your doctor a chance to update your personalized prevention plan to help you stay healthy and prevent illness.
There are many benefits to having a Medicare wellness visit. The visit gives you and your doctor time to talk about your overall health and any changes or concerns you may have. This is an important opportunity to catch any health problems early, when they are easier to treat. The visit also allows your doctor to update your personalized prevention plan. This plan can help you stay healthy and prevent illness by making lifestyle changes, such as quitting smoking or eating a healthier diet.
A Medicare wellness visit is an important part of staying healthy and preventing illness. If you have any concerns about your health, be sure to schedule a visit with your doctor today.
Don’t Miss: Will Medicare Pay For Shoes
Three Unique Codes: G0402 G0438 And G0439
Medicare preventive wellness visits fall into three categories the Welcome to Medicare Visit, also known as the Initial Preventive Physical Exam , the initial Annual Wellness Visit, and subsequent Annual Wellness Visits. Each has its own Current Procedural Terminology code that must be used in the right circumstances and proper order.
During the first twelve months a patient is enrolled in Medicare, they are eligible for the Welcome to Medicare Visit. This is a one-time visit that includes vital measurements, a vision screening, depression screening, and other assessments that are meant to gauge the health and safety of an individual patient. This visit must be coded using CPT G0402. Once a patient has been enrolled for more than twelve months, the G0402 code will be rejected regardless of whether the IPPE visit previously took place or not.
After a patient has been enrolled in Medicare for twelve months, they become eligible for an Annual Wellness Visit. If they completed an IPPE, the patient is eligible for the initial AWV on the first day of the same calendar month the following year. An AWV is similar to the IPPE but includes slightly different required and accepted screenings. This initial AWV must be coded using G0438.
The Medicare Annual Wellness Visit: What Is It And Why Does It Matter
Whether youve just turned 65 and are new to Medicare, or you have been receiving Medicare benefits for many years, you have likely heard of the Medicare annual wellness visit. You may have also been encouraged to participate by your insurance company and prompted to schedule an appointment with your primary care provider.
So, what exactly is the Medicare annual wellness visit, and why does Medicare want you to participate?
The Medicare annual wellness visit is a yearly appointment between you and your primary care provider that focuses on preventative care healthcare that focuses on preventing you from becoming ill, and keeps you healthy and out of the hospital. Medicare covers this visit at no cost to you, including no co-pays or deductibles.
You may be asking yourself why Medicare would pay for a free annual visit. Its simply because research shows that evidence-based preventative medicine helps reduce negative outcomes by preventing illness, promoting health and reducing overall healthcare costs. Focusing on preventative care helps your provider find and address potential problems before they become an issue. The overall goal of preventative healthcare medicine is promoting personal wellbeing while preventing disease, illness, disability and death. Prevention is the foundation for keeping you healthy and active while providing longevity and positive health outcomes.
Read Also: Does Medicare Have A Premium
What To Expect In An Annual Wellness Visit By Medicare
Usually, Medicare annual visits only focus on current or chronic issues. Once a year, Medicare will provide its users with the benefit of a free annual wellness visit. It should not be confused with an Initial Preventive Physical Examination , which is only available during the first 12 months of enrollment in Medicare Part B.
Only after a patient has had Medicare Part B for 12 months he or she becomes qualified for the Annual Wellness Visits. Medicare invests in these visits to keep its beneficiaries healthy. There are three parts involved in these visits:
- Scheduling the appointment
- Staff collecting necessary information
- Reviewing information and developing a prevention plan that is personalized
If you are in need of some counseling regarding your overall health condition and the treatments that you are receiving, then this visit will be very beneficial for you. It can also set you up on a new and improved preventive health plan that is personalized and considers your medical history as well as current medical conditions. It also discusses issues related to your referrals and private practitioners, trying to provide you with the best solutions available.
Initial Preventive Physical Exam
The Initial Preventive Physical Exam , also known as the Welcome to Medicare Preventive Visit, promotes good health through disease prevention and detection. We pay for 1 patient IPPE per lifetime no later than the first 12 months after the patients Part B benefits eligibility date.
HHS Pain Management Best Practices Inter-Agency Task Force Report has more information.
7.Screen for potential substance use disorders
Review the patients potential SUD risk factors and, as appropriate, refer them to treatment. You can use a screening tool, but its not required. National Institute on Drug Abuse Screening and Assessment Tools Chart has screening and assessment tools.
8. Educate, counsel, and refer based on previous components
Based on the review and evaluation services results in the previous components, provide appropriate education, counseling, and referrals.
9. Educate, counsel, and refer for other preventive services
Include a brief written plan, like a checklist, for the patient to get:
- Once-in-a-lifetime screening electrocardiogram , as appropriate
- Appropriate screenings and other preventive services we cover
HHS Pain Management Best Practices Inter-Agency Task Force Report has more information.
12. Screen for potential substance use disorders
1. Review and update Health Risk Assessment
- Get patient self-reported information
- You or the patient can update the HRA before or during the AWV it shouldnt take more than 20 minutes
Don’t Miss: Does Medicare Pay For Prostate Cancer Treatment
Whats The Medicare Code For Annual Wellness Visit
Medicare covers Annual Wellness Visits with two codes G0438, Initial AWV, and G0439, Subsequent AWV. See when to use these two codes for your patients
What is the ICD 10 code for a wellness exam?
Instead, it is billed with a Medicare-only code, G0402for the initial Welcome To Medicare exam. New Medicare annual wellness exams
When to use CPT g0439 for wellness visits?
CPT G0439 is used to code all subsequent Annual Wellness Visits that occur after the initial Annual Wellness Visit . So, if used correctly, G0439 would not be used until G0402 was used to code the IPPE, and G0438 was used to code the initial AWV.
Preparing Eligible Patients For The Annual Wellness Visit
Providers can help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:
- Medical records, including immunization records
- Detailed family health history
- Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
- Full list of current providers and suppliers involved in their care, including community-based providers , and behavioral health specialists
Part B covers an AWV if performed by a:
- Qualified non-physician practitioner
- Medical professional , or a team of medical professionals that a physician directly supervises
When you provide an AWV and a significant, separately identifiable, medically necessary Evaluation and Management service, we may pay for the additional service. Report the additional CPT code with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patients illness or injury or to improve the functioning of a malformed body part.
You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV and G0439 is for subsequent AWVs. Remember, you must not bill G0438 or G0439 within 12 months of a previous G0402 billing for the same patient. We deny these claims with messages of, Benefit maximum for this time period or occurrence has been reached and Consult plan benefit documents/guidelines for information about restrictions for this service.
Coding
Read Also: What Does Medicare Pay On Cataract Surgery
