Medicare Wellness Visits-An Often Missed Revenue Opportunity

Medicare Wellness Visits

Medicare covers wellness visits, and your patients pay nothing if you accept assignment. The Part B deductible doesn’t apply. You should recommend the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) to get your patients off to a healthy start this year and generate extra revenue for your physician office.

The Welcome to Medicare Visit

The IPPE or the “Welcome to Medicare” preventive visit is a one-time visit for newly-enrolled patients to the Medicare program. Your physician office should identify all patients who will soon become Medicare eligible and contact them to set up a future appointment.

This visit includes a review of the patient's medical and social history related to his or her health and education and counseling about preventive services, including these:

• Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
• Height, weight, and blood pressure measurements.
• A calculation of your body mass index.
• A simple vision test.
• A review of your potential risk for depression and your level of safety.
• An offer to talk with you about creating advance directives.
• A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

The Yearly Wellness Visit

The AWV or “Yearly Wellness Visit” focuses on preventive health. If a patient has had Medicare Part B (Medical Insurance) for longer than 12 months, he or she can get a yearly “Wellness” visit once every 12 months to develop or update a personalized prevention plan to help prevent disease and disability, based on your current health and risk factors. Your office may also perform a cognitive impairment assessment.

The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia and check for depression and other mood disorders. Your provider may order other tests, if necessary, depending on your general health and medical history.

The personalized prevention plan is designed to help prevent disease and disability based on the patient's current health and risk factors. You will ask the patient to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and the patient develop a personalized prevention plan to help the patient stay healthy and get the most out of the visit to your office. It can also include:

• A review of your medical and family history.
• Developing or updating a list of current providers and prescriptions.
• Height, weight, blood pressure, and other routine measurements.
• Detection of any cognitive impairment.
• Personalized health advice.
• A list of risk factors and treatment options for you.
• A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
• Advance care planning

For More Information:

• Medicare Wellness Visits educational tool
• Medicare Preventive Services educational tool
• Preventive Services webpage
• Information for your patients on “Welcome to Medicare” preventive visit and Yearly Wellness Visit

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.