The Annual Wellness Visit is a conversation between you and your doctor to discuss your health history, health concerns, and review your medications and immunizations. In Annual Wellness visits, the doctors review your existing health issues and prescribe the medicine accordingly. The whole purpose of the Medicare Annual Wellness Visit is to create a complete personal and family health family to avoid future health issues.

What services are covered?

During the first Annual Wellness Visit, a personalized prevention plan will be developed for you, which will include the following things:

  • Checking height, weight, blood pressure, and other regular measurements.
  • Conducting health risk assessment. You will receive a questionnaire that can be completed before or during the visit. This questionnaire consists of questions related to your health status, injury risks, behavioral risks, and severe health risks.
  • Reviewing functional abilities and level of safety, which includes screening for hearing impairments. Other abilities are also checked like bathing, dressing, etc.
  • Learning about family medical history
  • Screening diseases such as Alzheimer’s and any other forms of dementia.
  • Providing health advice or preventive counseling services aimed at reducing identified risk factors and promoting wellness. This includes weight loss, smoking cessation, nutrition, and others.

The Annual Wellness Visit after your first one will be different. In the next visit, your doctor should:

  • Examine your weight and blood pressure
  • Update the HRA which you completed
  • Update the medical history of your family
  • Update your list of medical providers and suppliers

Are you eligible for Medicare Annual Wellness Visit?

If you have enrolled in Medicare or a Medicare Advantage Plan, you will be eligible for these services from an in-network provider. The Annual Wellness Visit includes an HRA (Health Risk Assessment) as well. Enrollees get more preventive and wellness care benefits with the introduction of the Affordable Care Act. Beneficiaries save money by eliminating co-insurance, co-payments, and deductibles for a lot of services. (The coverage is provided as Medicare Part B benefit). The Annual Wellness Visit is utilized to develop a personalized prevention plan for the beneficiary. After the initial Annual Wellness Visit, enrollees are eligible for a follow-up visit every 12 months.

In short, you are eligible if:

  • You had Part B for over 12 months.
  • Or, you have not received an Annual Wellness Visit in the past 12 months.

Also, you cannot receive your Annual Wellness Visit within the same year.

What are the costs?

If you fit the eligibility criteria, then Medicare covers the Annual Wellness Visit at 100% of the approved amount when you seek service from a participating provider. This means you pay nothing (i.e., no deductible).

If your doctor discovers or treats a new problem during Annual Wellness Visit, this additional care will be considered diagnostic. Medicare will bill you for any diagnostic care you receive during a preventive visit.

Conclusion

We would like to conclude by saying that it is also essential to accurately bill the Annual Wellness Visit. If found inappropriate, a penalty will be imposed. Also, insurance eligibility verification is among the services provided by a medical billing firm, which decides whether you are eligible to receive the services provided. Next time, if you are planning for a Medicare Annual Wellness Visit, do keep all these points in mind.

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