MEDPAGE Primary Care: Medicare’s ‘Wellness Visit’ Money Goes Unclaimed

Launched with great fanfare, wellness codes leave docs frustrated.

By Cheryl Clark, Contributing Writer, MedPage Today 

9.03.2015 – A huge victory in primary care doctors’ quest for better Medicare payment came Jan. 1, 2011, or so they hoped.  That’s when six pages of the Patient Protection and Affordable Care Act kicked in, authorizing three novel billing codes so that as many as 33 million beneficiaries enrolled in Medicare Part B could receive “annual wellness” visits to help them thwart disease. Nationally, the amounts are significant, paying from $118 to $174 for each code, and possibly more in some locations.

That’s billions of dollars worth of care physicians couldn’t bill before. It pays not for dealing with patients’ symptoms but for reviewing their screening tests and immunizations, family history, cognitive and physical abilities, risk for falls, and for designing a “personalized prevention plan” for every beneficiary.

It is, said, Reid Blackwelder, MD, board chairman of the American Academy of Family Physicians, a time “for patients and doctors to take a breath, and focus on looking ahead at risks they need to be aware of. It’s a different mindset about care.”

Better still, there’s no 20% co-payment required as in normal Part B services.

Doctors already provided some of this care, but often in a choppy, haphazard way, squeezing admonitions about extra pounds, smoking, or alcohol use during other office visits.

But despite this potential largess for primary care, physicians have been slow to submit claims. For the third year of the new codes, only 12% of eligible beneficiaries had Medicare billings for these services, according to 2013 data from the Centers for Medicare and Medicaid Services.



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