The Affordable Care Act (a.k.a. Health Reform, Obamacare) mandates that Medicare provide an annual wellness visit (AWV) to all beneficiaries free of charge. Today, I answer some questions related to CMS’s implementation of the mandated annual wellness visit requirement.
What is included in an annual wellness visit? The AWV includes “the establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index (BMI) or waist circumference, and blood pressure (BP), with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B.” Care coordination is also a key component of the AWV. The AWV should establish a list of current providers and suppliers that are regularly involved in providing medical care to the individual. Depression screening, review of the individual’s functional ability, and verifying whether the patient has received preventive care recommendations (as defined by the USPSTF and ACIP). Additional information on the services provided during an AWV is available here.
Who can provide an annual wellness visit? Providers eligible to provide an AWV include doctors of medicine or osteopathy, physician assistants, nurse practitioners, or clinical nurse specialists. Other medical professionals (e.g., health educator, dietitian) can conduct the AWV under supervision of an MD or DO.
What is a PPPS? Beneficiaries who see a physician for their AWV receive Personalized Prevention Plan Services (PPPS). The PPPS are the services the physician is required to provide during the AWV.
How much does an AWV cost patients? Unlike typical physician visits covered by Medicare Part B, the patient is not responsible for any coinsurance or Part B deductibles.
I am a provider. How do I bill Medicare for an AMV? There are two HCPCS codes one can use to bill Medicare depending on whether this is the beneficiary’s first wellness visit or not:
- G0438: Annual wellness visit, including PPPS, first visit
- G0439: Annual wellness visit, including PPPS, subsequent visit
Are all Medicare beneficiaries eligible for an AWV? The answer is no. Newly enrolled beneficiaries are not eligible for a wellness visit; only beneficiaries who have been enrolled in Medicare Part B for at least 12 months are eligible for a wellness visit. New enrollees, however, are eligible for the new enrollees are instead eligible for the Initial Preventive Physical Exam (IPPE) which is billed under HCPCS G0402.
I had my Wellness exam this year. I was called and told it was mandatory. That’s why I ended up on this site. I had not found that it was mandatory. I’ll have to say that my experience was not that bad. I was not asked a lot of embarrising questions. I was not asked to draw anything in circles. I was asked to walk across the room. Of course I had been complaining about my feet anyway. The nurse practioner did mine. She happens to be my doctor’s wife. I have a pretty good relationship with my doctor and his wife. She did volunteer that Medicare required them to make sure that their patients have certain prevention tests and vaccines or it did show up bad on their record and that they didn’t get paid as much for their visits by Medicare. My visit was not unpleasant although I too feel that I didn’t need it as I go every six months or so anyway. My husband has his visit today and his remarks will not be the same I can assure you. He does not want to go and I will not tell him about all these comments or he might not go and I think I’ve read they charge if you don’t cancel within twenty four hours.
I received a call that I am due a “follow up” visit just after my yearly visit 3 mos. ago. I began reading up on this and am trying to find out if this ridiculous visit is mandatory. Does this mean I will not receive Medicare coverage if I don’t go? Does it mean my doctor will no longer see me if I don’t go? She already knows all of the information they are going to ask of me anyway. Wow! All the paper work and time spent for something that can be discussed during your yearly visit. I have supplemental insurance with a large hospital chain in Tex. Does this mean that all docs in this chain are “required” or urged to be participants in this Medicare “Wellness Visit?” If she dismisses me for not attending, will I be able to get another doctor in this chain? I am really ticked over this most absurd “Wellness Visit. Does anyone know the answer to my questions?
I, too, am wondering if I can refuse the “wellness exam”? If it is not mandatory by Medicare how can a physician force you to take it? Don’t we as patients have a right to refuse any test,etc?
The annual wellness exam is elderly profiling. Contact your state representatives, as well as, your U.S. congressman and senators to voice your concerns about these intrusive and unconstitutional requirements. Time to say NO, I WILL NOT COMPLY.
Okay, I thought it was only me! My husband retired in May so I lost his private insurance and had to join Medicare. I’m 57 years old but have Helen medically disabled since 2005 because of MS.I unknowing went to for my annual check up, mostly to get my blood work monitored. WOW! I was given tons of papers to fill out which I felt totally overstepped the bounds of medical information, even though I had previously thought I had bared all for disability! Then the doctor didn’t put a hand on me as far as exam went, he just tapped away on his computer and asked if I felt safe in my home and said I needed a colonoscopy. He also said I didn’t have a bone density test, which I did have last year but they apparently lost my records. His assistants gave me a dementia test which was about 20 questions like spell “World” backwards. Write a 5 word sentence on this paper. “Read this sentence and do what it says”, it said “close your eyes”. I was sooooooo humiliated, but by the time I got home I was angry! I felt like I was bullied, and I should have refused, but I was afraid they would have retaliated by interfering with my disability insurance. I already am having a problem getting my MS medications without going bankrupt! And the war on opiates have left my neurologist afraid to order pain medications anymore! This has been awful!
Welcome to UNITED STATES OF SOCIALISM your government owns you! However I will not submit to all the exams I don’t need or the over priced medications that are worse than the affliction the useless tests like BONE DENSITY EXAM’S sorry the doctors assistant at Kaiser hung up on me when I said I only see the doctor when needed & I will not take drugs either.
I am returning to a Family Care physician I saw for several years , but then I got a new physician who was very good but left his practice to become a hospitalist. The next doctor I saw did not even send a letter telling me she was also becoming a hospitalist. When I spoke with the office manager at the former doc’s office, she said I would have to take the Wellness Exam. I did not have a clue what it was. She explained colonoscopy, mammogram, pap smear, blood work, etc. and said I could refuse it, but it would cost the clinic. I am almost 75. After reading letters from others, I don’t want to take it. I didn’t want to take it before reading them. However, I need my asthma prescriptions so I may not have a choice. I live in a rural area where physicians are few .
I intend to refuse this exam ,and I feel like it is just another invasion of privacy. My clinic says I can refuse it, but that the clinic will be “punished” and must pay a fee if I don’t take it. I am almost 75 and I simply do not want to have a colonoscopy, mammogram, blood tests, pap smear,etc.( I just had a CBC at the clinic I was going to before the physician became a hospitalist without informing me.)
I objected to the Medicare Annual exam and refused to fill out the paper work. My Doctor told me it was mandatory and if I refused she would not get paid. I am 76,a martial arts student and a yoga instructor.I am in excellent health. I found the questions insulting and humiliating. I will refuse the exam in future and only see my Doctor on an as needed basis, i.e., colds, flu, infection etc. The exam was a source of depression and irritation. It was intrusion and left me feeling as though I was old and feeble, which of course, I am not.
I, too, have been subjected to this most invasive “wellness” exam. I, too, was told that if I did not participate, my doctor would be punished financially by Medicare. I found the test insulting, degrading, and an overreach by the government. I hope that the many complaints you are receiving from people like me will reach those in power and will cause the government to get rid of this invasion of our privacy and waste of money.
I too was told that if I did not participate in the health wellness exams that they would drop my medications and none would be renewable. Well I called medicare I was told that it is not mandatory. so I don’t have the exams,
Today I was told by a doctor and a nurse that the wellness exam is mandatory. I said no it isn’t and I have not had one. I was told that I was in trouble. My brother-in-law’s doctor demands that he have a wellness exam. I make his appointments and am constantly being hounded about this. I want his medical problems followed on a regular schedule and not worry about the wellness. This doctor’s office refuses to do this. We met with the wellness nurse because the office refused to schedule an appointment for his problems. He ended up in the emergency room and hospital. Still, I am constantly hounded about a wellness visit. He has serious health problems but it is difficult to get the doctor to talk about them. Just demands a wellness visit.
I have always gone in every 6 months because of the meds I take. I also told them I am not doing a Welcome to Medicare visit. When I went in for my second 6 month follow up, I was scheduled for 2 appointments. Really? Then I was told my united healthcare that it is not mandatory. I am in perfect health. The sad think is a lot of money to do these stupid questions. I told the nurse I didn”t schedule the welcome visit and did not want it. They snuck in a few questions, I had my guard up. They better not do it again or I will walk out. Really fed up with all of theis. I refused all tests also. Last I checked we are still in America. NO ONE WILL TELL ME WHAT I HAVE TO DO, THIS IS MY BODY NOT THEIRS.
I just called and cancelled my “wellness” appointment. Thanks for the warning, I suspected the so-called wellness test was just an invasion of my privacy in the first place.
United Health care is hounding me as well. After reading these posts I am sure that I’m not going for a so-called “wellness check” LOL. It’s just another way for big brother to invade my privacy and gather information that they have no right too. Thanks Barry and the unaffordable ACA!
Agree wellness test is mostly waste of time but worse – it isn’t designed to spot real diseases. We old people – I’m 84 – know nature works to get rid of us. But modern medicine can sometimes delay the process if we know about it early. My wellness test bore no resemblance to an actual physical exam.
And it was not free. I asked as question, which turned it into a consultation costing me and Medicare extra. Then I got another bill for “services.” There were no extra services, but the billing people say they can charge extra because a hospital owns the medical practice. This is a abuse of Medicare. And me.
Deborah Smith, if you go on straight Medicare and get rid of your HMO you can refuse the Wellness exam.
A wellness visit should be free. I am having issues having this forced upon me as well. Last I checked, I was living in a free country. I never asked to be part of Medicare, but when I started working at age 16, they just took my money. Now that I am Medicare age, I still have to pay a premium and have these things forced on me???? Thanks Obama. Waste of taxpayer money as far as I am concerned.
If I get too many calls concerning wellness visits, I may leave the United States — especially if anything happens to my husband. We did consider at one time doing just that. But, he is now too sick with a heart condition and arthritis for a realistic big move. Like I said in a previous post, I have no GP and if I really get sick I would use my husband’s. So far at age 68, I am not currently sick or on any meds. I definitely do not trust big pharma or the medical industry in general.
Today was the first time that I have heard about the Wellness Exam. I let them schedule the appointment til I could come to research. After reading all the post tonight, I will be calling to cancel. My doctor stressed how important this was now I know more about why. It is hard to have any privacy and am not going to give what I have away. Plus the money for the for testing is way more than my fixed income. Chalk another stunning idea up to Obama.
Anytime the government comes up with a program like this you should be very wary of it. The old saying “follow the money” applies here. Tell your money grabbing doctor to treat you and not give in to the government. In addition your appointment time is yours and not time for the doctor to pick at his laptop.
I found a new doctor who is not a pusher of wasteful government projects like AWV. Don’t let your doctor push you around. AWV is not mandatory!
The wellness exam is a complete and total waste of time and rapidly dwindling medicare resources. What is the point of going over your medical history and reinventing the wheel? Every year? Demeaning, intrusive, and insulting stupid questions. It’s not like senility or Alzheimers would be difficult to spot if the doctor communicates with patients at all. The rub being, they usually don’t. I had my “wellness” visit last week. Now that I’ve had the pleasure of watching the doc type in the computer, go over the medical history they already had, and had my pat on the head, I feel so much better now. Gah. I don’t even like going to the doc when I actually need to because they sit and look at me like I have two heads and I’m talking in a foreign language and refuse to answer even simple questions. Never again.
The wellness check is insulting and invasive of privacy issues. My doctor’s office pushes it like crazy. When I go to my doctor I want time to address the physical symptoms that may be bothering me. I want him to listen and I want his understanding. I DO NOT WANT A QUIZ!,
I discharged my doctor yesterday because of a heated discussion about the scheduling date as established by Medicare and the date that my insurance says it will pay the doctor for the “annual wellness exam.” I had been a patient of this doctor for about 5-6 years with no prior disagreements. But I was out of patience with his refusal to provide the AWE when I wanted it and when he said it had to be done. He had previously told me the reason was because he would get paid if a full calendar year had not passed since my last one. That is not true as I verified with my insurer that he would be paid so long as the exam was done any time in the year following the previous on – even on Jan 1 if it could be scheduled. I didn’t mind filling out the 5 pages of “stupid” questions preliminary to the exam even though the remain exactly as they have for the past 15 years except for a minor or major surgery here and there. Not satisfied that the doctor was refusing to do as I requested, I reported him to his bosses telling them how he talked down to me in a condescending manner and in an overly loud voice as if I were a bum on the street. Doing that, aside from removing my care to another doctor is about the only recourse you have. I will no longer schedule the AWE with my new primary care physician.
I discharged my doctor yesterday because of a heated discussion about the scheduling date as established by Medicare and the date that my insurance says it will pay the doctor for the “annual wellness exam.” I had been a patient of this doctor for about 5-6 years with no prior disagreements. But I was out of patience with his refusal to provide the AWE when I wanted it and when he said it had to be done. He had previously told me the reason was because he would not get paid if a full calendar year had not passed since my last one. That is not true as I verified with my insurer that he would be paid so long as the exam was done any time in the year following the previous one – even on Jan 1 if it could be scheduled. I didn’t mind filling out the 5 pages of “stupid” questions preliminary to the exam even though they remain exactly as they have for the past 15 years except for a minor or major surgery here and there. Not satisfied that the doctor was refusing to do as I requested, I reported him to his bosses telling them how he talked down to me in a condescending manner and in an overly loud voice as if I were a bum on the street. Doing that, aside from removing my care to another doctor is about the only recourse you have. I will no longer schedule the AWE with my new primary care physician.