Medicare wellness visits causing confusion

When the Affordable Care Act first went into effect, one of the perceived benefits for physicians was the three new billing codes that cover various “wellness visits” for Medicare Part B patients. But so far, the perk is failing to live up to expectations.

The visits in question include a “Welcome to Medicare” preventive visit for new patients and yearly wellness visits for patients who have been on Part B for more than 12 months. In theory, these are a huge benefit to both physicians and patients, because the physician gets to slow down, set a specific amount of time aside to review the patient’s medical history and provide personalized health advice. The entire visit is then billed to Medicare, with no co-pay.

As recently reported by MedPage Today, however, primary care physicians have been slow to submit codes for wellness visits, with just 12 percent of eligible Part B beneficiaries receiving these services.

One of the primary problems, as MedPage Today’s analysis points out, is that certain topics can’t be discussed or the appointment can’t technically be billed as a wellness visit. Patients in a doctor’s office ask about various issues they have been having, but the physician is put in the awkward position of saying, “we can’t talk about that at this time” or, “come back again and we can talk about that.”

Physicians don’t like saying this, patients don’t like being told this, and it often leads to something else being billed to Medicare altogether, or, at the very least, upset patients who may share the negative story of their visit with others

Another common problem physicians are encountering with wellness visits is that patients expect a full physical. Again, this often leads to confusion and unhappy patients.

Medicare’s website includes detailed information about these wellness visits.