"Welcome to Medicare" and "yearly wellness" visits

When you first enroll in Medicare Part B, Medicare provides an initial "Welcome to "Medicare" visit.  This initial "Welcome to "Medicare" visit is different than the Annual "Wellness" visits that Medicare provides.  There is some confusion about these two types of visits, so we have provided some highlights of what is included with each of these visits below. 

"Welcome to medicare" visit

Per the Medicare website, "This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:

• Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
• Height, weight, and blood pressure measurements.
• A calculation of your body mass index.
• A simple vision test.
• A review of your potential risk for depression and your level of safety.
• An offer to talk with you about creating advance directives.
• A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services."

The "Welcome to Medicare" visit must be completed within 12 months of your Medicare Part B effective date.  There is no cost to the Medicare Beneficiary for the "Welcome to Medicare" visit, unless the doctor identifies/diagnoses any additional conditions, tests, etc.

Annual "Wellness" Visit

AAfter the first 12 months on Medicare Part B, the Medicare Beneficiary is entitled to an Annual "Wellness" visit.

Per the Medicare website:

"The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia and check for depression and other mood disorders. Your provider may order other tests, if necessary, depending on your general health and medical history.

The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:

• A review of your medical and family history.
• Developing or updating a list of current providers and prescriptions.
• Height, weight, blood pressure, and other routine measurements.
• Detection of any cognitive impairment.
• Personalized health advice.
• A list of risk factors and treatment options for you.
• A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
• Advance care planning"

We hope this provides some clarity about the differences between the "Welcome to Medicare" versus the Annual "Wellness" Visits.  It is also important that Provider billing offices understand these differences.  We have had some issues with Provider billing offices attempting to bill the Annual "Wellness" visit codes to Medicare when someone was still in their first 12 months of Medicare.  This results in declined claims because the Annual Wellness visit is only available once per year starting 12 months after the Part B effective date.