Medicare annual wellness visits: A ‘golden opportunity’ for DOs

Medicare annual wellness visits provide a forum for physicians to get to know their patients and partner with them to improve health. That’s according to Linda F. Delo, DO, a family physician in Port St. Lucie, Florida, who recently presented on Medicare annual wellness exams at OMED 2015 in Orlando.

“These exams are a golden opportunity for us to be osteopathic physicians—this is when we’re getting a good picture of the patient’s whole health situation,” she explained. By documenting the care they provide at these visits, physicians can also boost their bottom line. Dr. Delo noted that $75,000 of her practice’s revenue in 2014 came from Medicare annual wellness exams.

A health overview, not a complete physical

Medicare annual wellness visits aren’t meant to be a complete physical, but instead allow the physician to conduct a health risk assessment and work with the patient to develop a written long-term plan for wellness. Ancillary staff such as advanced registered nurse practitioners and physician assistants can conduct much of the exam, with the physician reviewing the health risk assessment with the patient.

Medicare patients receive one wellness visit per year, which is not subject to a deductible or co-insurance. However, Dr. Delo noted, patients are responsible for any additional care provided, so it’s important to let them know in advance what is and isn’t covered as part of the annual wellness visit. “For patients who have a list of questions to discuss, we suggest scheduling two appointments, one to discuss medical problems and another for the Medicare annual wellness visit,” she explained. If the annual wellness visit and additional care do take place in the same appointment, bill the additional items using Modifier -25.

What’s in an annual wellness visit?

There are three types of Medicare annual wellness visits. Documentation requirements and covered screenings vary slightly; to learn more, view the AOA’s related webinar.

• Initial preventive physical exam (G0402): Must be done within 12 months of the day the patient’s Medicare coverage took effect. This exam can only be done once in a lifetime.
• Initial annual wellness visit (G0438): This exam is also limited to once in a lifetime, but patients can receive it anytime after their Medicare coverage begins. For patients who received an initial preventive physical exam, this would be their second Medicare wellness visit; for patients who missed the 12-month window for the initial preventive physical exam, this visit would be their first.
• Subsequent annual wellness visit (G0439): Must happen at least 12 months after the patient’s Medicare coverage took effect. The patient must not have received an initial preventive physical exam or an annual wellness visit during the last 12 months.

Because these exams are limited to once per year or once per lifetime, depending on the type of exam, Dr. Delo recommended checking with patients to be sure they haven’t sought these visits from another physician.

Putting your EMR to work

To ensure proper documentation, Dr. Delo suggested setting up checklists and templates in your electronic medical record (EMR) system. Templates should include items like medical, family and social history; vital signs; functional ability and safety; and screening for depression or alcohol abuse, if provided. “You can put your EMR to work for you to generate revenue and meet clinical quality measures,” she explained. “This is care we’re already providing; we just have to document it.”