The Annual Wellness Visit (AWV) is a Medicare specific annual health status check where patients have vitals and health status indicators assessed, to provide an opportunity for earlier support and intervention for chronic conditions or concerns. An AWV is not the same type of exam as an annual physical. AWVs and annual physicals are assessed and billed differently. An AWV is only for Medicare patients and a broad range of health care providers can do the visit – broader than can for the physical.
There is often confusion with the term “annual wellness visit” and it’s similarities to an annual physical exam. Both services include the collection of vitals such as blood pressure and body mass index, Otherwise, there is a clear distinction between the two types of visits.
Yearly physicals include an examination by the primary care provider (including doctors, nurse practitioners, or physicians assistants) of the patient’s body and current health. They also can be completed for any patient, regardless of age. In contrast, AWVs can be performed by a wider variety of medical professionals, extending to clinical nurse specialists and nurse practitioners.
And, the AWV does not require a physical exam, but rather is a preventive service that assesses aspects of a Medicare patient’s self-reported health status, family history and medical history to identify risk factors. This is done through a health risk assessment (HRA), which is a questionnaire that the patient can complete on their own.
Once the questionnaire is complete, a personalized prevention plan is generated that alerts the provider of risk factors, preventive services to move forward with, and offers opportunities for tertiary follow up services and treatment options. Unlike annual physicals, AWVs can only be completed for eligible Medicare beneficiaries.
Since an AWV is classified as a “preventative” service by CMS, patients have no copay or financial obligation.
AWV Eligibility & Importance of Proper Scheduling
Within their first year of Medicare part B coverage, all Medicare beneficiaries are eligible for the IPPE, or “Welcome to Medicare” visit. After that, each beneficiary is eligible once per year for a Medicare annual wellness visit that requires no coinsurance (copayment). An AWV can only be performed every 12 months. It’s important to be accurate on the timing and to ensure no one else has billed for it, or reimbursement can be at risk.
This can be very confusing and complicated for the patients, so reliable software and informed staff who do outreach and schedule AWVs (often as part of other chronic care management) can help to ensure that all the criteria are properly met when scheduling.
Benefits of AWV
Early identification of AWV eligible beneficiaries allows providers to potentially prevent or improve chronic conditions for Medicare patients, yielding better health outcomes, reduced costs and disease management and even prevention. Annual Wellness visits also yield reimbursement for providers and health systems.
In the value-based care environment, where shared savings depend on keeping patients healthier for longer, primary care providers can use a powerful tool for delivering proactive, preventative care: the Medicare Annual Wellness Visit (AWV).