Doctors Worried About Nonphysician Entities Providing Medicare Wellness Visits

TMA officials remind physicians they can provide Medicare annual and first-time "Welcome to Medicare" wellness visits to their patients and warn that nonphysician health care entities may be beating doctors to the punch, albeit legally. "Welcome to Medicare" visits occur within a patient's first 12 months of having Medicare Part B coverage.        

Medicare rules do not require primary care physicians to provide the service but allow a range of health professionals to give the exam, including physicians; qualified nonphysician or licensed practitioners, such as physician assistants, nurse practitioners, clinical nurse specialists, and registered dietitians; or a team of such medical professionals working under the direct supervision of a physician.

TMA has received complaints that newer companies focusing on long-term and preventive care are offering the Medicare wellness checkups, sometimes unknown to the patient's doctor. After the fact, physicians may receive a notice from the company stating it already provided the service, for example, by a certified nurse practitioner.

Physicians worry the nonphysician entities are contributing to patient confusion and fragmented care because patients may receive generic or incomplete medical guidance from someone unfamiliar with the patient's history. Nor can physicians claim Medicare payment for the wellness visit once another company performs the same service, due to frequency limits.   

TMA's Payment Advocacy Department staff strongly encourages physicians to verify Medicare patients' eligibility for preventive services through Novitas, the state Medicare contractor. Either by phone or through Novitas' online portal, physicians can check the date of patients' last annual wellness visit. They should also consider sending out reminders to patients before their annual wellness visits are due, prompting them to contact their doctors directly for an appointment.

For more information, download a free Medicare quick-reference guide on annual wellness visits.

Physicians may also issue an advance beneficiary notice (ABN) if they believe the wellness service may exceed the frequency limitation. The ABN alerts patients they may be financially liable if Medicare denies the claim. Physicians can only collect from the patient when Medicare denies the service if they issue a valid ABN. Read the rules in this guide from the Centers for Medicare & Medicaid Services. 

Action, Oct. 31, 2014

Last Updated On

October 30, 2014

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