Combining Medicare AWV, Annual Physical with No Copay

How many Medicare patients are in your patient base? How many of them come in at least once every year for an annual physical? How many would come in if you contacted them and offered an annual check-up with no out-of-pocket cost? Multiply that number by at least $185 and up to $220 or more.

You know that Medicare does not cover the 99387 new patient and 99397 established patient annual physical exams. Therefore, many patients either object to or ignore them because of their out-of-pocket expense. You should also know by now that the Medicare Annual Wellness Visits (G0438 AWV and G0402 IPPE) do not include reimbursement for or require physical exam components.

But, you can provide those elements and just not bill for them. If you plan well by using pre-visit electronic data capture via a patient portal or Internet service, the whole AWV and PE can be completed in 30 minutes. Comparatively, that revenue is also more than a 99214.

Why would you not charge for the annual physical exam components?

The answer is to get the patient in the office to provide them with the best healthcare. You also discover potential conditions that you can treat and bill for later.

It has been estimated that AWVs generate at least $200 more in reimbursement for conditions and tests in the ensuing 12 months.

Are you losing money by only billing for the wellness codes and not the physical exam?

Compile a spreadsheet and analyze the percentage of eligible patients to whom you provide an annual physical and the number of patients to whom you have provided an AWV since it began last year. Nationally, less than 8 percent of eligible patients are coming in for wellness visits.

If you have 500 Medicare patients and only 200 are coming in for an annual physical at $132 average less the copay, will you generate more money if you can provide 350 AWVs at $166 to $220 initially and then $109 to $164 with allowable annual screens every year with no copay? Remember, many patients object to coming in for both, especially the AWV with no treatment or physical exam.

Many studies have proven that reducing or eliminating out-of-pocket expense dramatically improves participation by Medicare patients. Your goal should be at least a 20 percent increase in annual visits and could easily be 50 percent or more.

Don’t forget the “goodwill” of telling your patients you will provide them with an annual physical at no out-of-pocket versus most practices that charge for them.

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