{"id":20469,"date":"2018-09-17T08:00:32","date_gmt":"2018-09-17T12:00:32","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=20469"},"modified":"2025-10-21T17:13:04","modified_gmt":"2025-10-21T17:13:04","slug":"medicare-wellness-exam-mandatory","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/medicare-wellness-exam-mandatory\/","title":{"rendered":"Is the Medicare Wellness Exam Mandatory?"},"content":{"rendered":"

Medicare covers<\/span><\/a> a \u201cWelcome to Medicare\u201d visit and annual \u201cwellness\u201d visits. <\/span><\/p>\n

While both visit types are available to Medicare recipients, recipients aren\u2019t required to participate in either visit type to maintain their Medicare Part B coverage.<\/b><\/p>\n

Annual wellness visits: Not required, but worth it?<\/span><\/h2>\n

Medicare recipients are eligible for an annual wellness visit once they\u2019ve had Medicare Part B for 12 months or more. According to <\/span>Medicare.gov<\/span><\/a>, \u00a0the goal of the visit is to develop or update a personalized prevention plan, \u201cdesigned to help prevent disease and disability based on your current health and risk factors.\u201d <\/span><\/p>\n

Patients complete a health risk assessment, and providers typically complete a medical and family history review as well as take patients\u2019 height, weight, blood pressure, and other routine measurements. Providers may also discuss recommended preventative services and screenings. <\/span><\/p>\n

In an opinion piece for <\/span>STAT<\/span><\/i>, \u201c<\/span>Does Medicare\u2019s free annual wellness visit do any good?<\/span><\/a>\u201d, Ishani Ganguili, MD, an instructor of medicine at Harvard Medicine School and primary care physician at Brigham and Women\u2019s Hospital, questions the utility of the annual wellness visits. <\/span><\/p>\n

Dr. Ganguili says that while the exam requires clinicians to \u201crun through a lengthy list of tasks like screening for dementia and depression, discussing care preferences at the end of life, and asking patients if they can cook and clean independently. . .Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.\u201d <\/span><\/p>\n

Patients who see the annual wellness exam as a substitute for an annual physical, therefore, may miss out on the opportunity to be thoroughly examined by a physician as they would be during the annual physical. Medicare does not pay for the comprehensive exam that most people think of when they think of \u201cphysical.\u201d <\/span><\/p>\n

Another potential problem with the annual wellness visits, Dr. Ganguili notes, is that many patients end up with unexpected medical bills from what they thought was a free checkup. While the basic wellness exam is free, if a provider discovers an issue during the visit, like knee pain or a cough, they are allowed to bill for the evaluation of that issue. <\/span><\/p>\n

In looking at data from the year Medicare first began covering annual wellness visits, 2011, through 2014, Dr. Ganguili and her colleagues found that only 8 percent of those eligible had an annual wellness exam in 2011. Sixteen percent of those eligible had a wellness visit in 2014. \u00a0Out of the rather small percentage of eligible patients who are participating in annual wellness visits, they found that non-white patients with higher medical risk who were dually enrolled in Medicare and Medicaid were the least likely to receive an annual wellness exam. <\/span><\/p>\n

While Dr. Ganguili says the exams represent a needed effort to direct more resources and attention towards primary care, she also says we must ask the same question of them as we should of all healthcare programs: \u201cDoes it have a measurable impact on the outcomes we care about, like keeping patients healthy and out of the hospital?\u201d <\/span><\/p>\n

More patient outcome data is needed to determine whether more resources should be invested in increasing access to and utilization of annual wellness visits. <\/span><\/p>\n

DUMMYTEXT<\/span><\/p>\n

Resources:<\/b><\/h4>\n