What is an Annual Wellness Visit?
An Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider to discuss your health and develop a personalized prevention plan. The visit is an opportunity to update your medical history, review your current health status, identify any health risks, and address any concerns you may have.
However, billing for AWVs can be complex, and if you don’t do it correctly, you could be leaving money on the table. This article will go over everything you need to know about billing for AWVs, including when you can bill for them, what services are covered, and how to maximize your reimbursement.
Why are Annual Wellness Visits important?
Annual Wellness Visits are essential because they help patients to stay on top of their health. Patients can ensure that any health concerns are caught early and treated effectively by coming in for regular check-ups. Additionally, these visits allow them to develop a relationship with their primary care provider so that they feel comfortable discussing their health with them.
AWVs also allow patients to receive comprehensive health assessments and risk factor reduction counseling, which can help them stay healthy and avoid costly medical problems down the road.
Types of Medicare Annual Wellness Visits
There are three types of Annual Wellness Visits:
1. Initial Preventive Physical Examination (IPPE)
This visit is also known as the “Welcome to Medicare” visit. It is covered by Medicare Part B and is for patients who are new to Medicare. The visit includes a reviewing medical and family history, a physical exam, and education and counseling about preventive services.
2. Initial Annual Wellness Visit (IAWV)
This visit is covered by Medicare Part B and is for patients who have had Medicare Part B for more than 12 months.
3. Subsequent Annual Wellness Visit (SAWV)
After 11 months of IAWV, patients can schedule a SAWV. The visit must be with the same primary care provider or medical team who delivered the IAWV.
How Much is the Payback for an Annual Wellness Visit?
Even though all types of Annual Wellness Visits (AWV) are covered 100%, the amount that Medicare will reimburse for an Annual Wellness is billed in 3 different codes:
- Initial Preventive Physical Examination (IPPE) uses code G0402 with an average of $168.89.
- Initial Annual Wellness Visit (IAWV) code G0438 can bill an average of $174.28.
- Lastly, the Subsequent Annual Wellness Visit (SAWV) can bill $117.86 on average with code G0439
When can you bill for an AWV?
You can bill for an AWV once every 12 months for each patient. However, if a patient has had a significant change in health status, you may be able to bill for an additional visit.
What services are covered under an AWV?
There are three main components to an AWV: the health risk assessment (HRA), the physical exam, and the counseling/education.
The HRA is a questionnaire covering a patient’s medical history, family history, lifestyle, and risk factors. You can use an HRA to generate a personalized health plan for each patient.
The physical exam component of the AWV can vary depending on the patient’s age and health status. For example, patients over the age of 65 will generally have a more comprehensive exam than younger patients.
The counseling and education component helps patients understand their risks and make lifestyle changes to improve their health. This may include counseling on diet, exercise, smoking cessation, and other risk factors.
Barriers to Annual Wellness Visits (AWV)
A few barriers can prevent you from optimally billing for AWVs. First, many providers are not aware of the different types of AWVs and how to bill for them correctly. Second, some providers do not have the time to complete all three components of the visit, so they only bill for the physical exam or the HRA. Finally, some patients may not be aware that they are eligible for an AWV and may not schedule one.
Conclusion
It is crucial to understand the different types of AWVs and how to bill for them correctly to maximize revenue. It is also essential to complete all three components of the visit so that you can bill for the entire visit. Finally, it is important to educate your patients on the importance of AWVs and make sure they are aware of their eligibility.
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