A visit governed by the calendar
Annual wellness visit program support is, first, a scheduling operation. The Medicare annual wellness visit is a planning visit: a health risk assessment, a review of history and current clinicians, basic measurements, screening for cognitive and mood concerns, a look at function and safety, and a written prevention plan with a screening schedule. It is not a head-to-toe physical.
Eligibility turns on dates. It depends on how long the patient has had Part B and when the last wellness visit or initial preventive visit took place. A practice that does not track those dates either misses patients for years or schedules visits before they can be billed.
Gateway helps practices in Greater St. Louis and the Metro East run the calendar, then follow through on what each visit finds.
Building the eligible list
We start with the practice’s Medicare panel and build a list that shows, for each patient:
- Coverage type, since traditional Medicare and Medicare Advantage plans handle wellness visits differently
- The date of the last wellness or initial preventive visit, from the practice’s records and the payer’s eligibility information
- The earliest date the next visit can take place, as the practice verifies it
- Whether the next visit would be a first or a subsequent wellness visit
Patients who have never had a wellness visit and patients who are overdue go to the top.
Outreach and scheduling
Many patients hear “annual wellness visit” and expect a physical. Outreach works better when it says plainly what the visit is, what it is not and what to bring. Our patient guide to what an annual wellness visit covers can go out with the invitation.
Under the practice’s direction, we handle invitations, reminders and rescheduling. Questions about cost go to the practice and the plan. We do not tell patients that a visit is a covered benefit, and other services addressed on the same date may be billed separately.
Preparing before the visit
A wellness visit runs out of time when the questionnaire is started in the exam room. Before the visit we help collect:
- The health risk assessment, completed on paper, by phone or through the practice’s portal
- A current list of medications and supplements
- The names of other clinicians and suppliers involved in the patient’s care
- Dates of screenings and vaccines done elsewhere
- Any advance directive on file, and whether the patient wants to discuss one
The clinician reviews this material and conducts the visit. Who on the practice’s team may perform which parts, and under what supervision, is set by the billing rules and confirmed by the practice.
Care-gap follow-up
The output of a wellness visit is a list: screenings due, vaccines to consider, referrals, a fall-risk or memory concern to look into, an advance care planning conversation the patient asked for. Without follow-up, the plan sits in the chart until next year.
We turn the plan into tracked items. Each has a status: ordered, scheduled, completed, result received or declined by the patient. Open items are reviewed with the practice on a regular schedule, and results that come back are routed to the clinician.
The same tracking supports quality reporting. Practices in value-based arrangements can connect it to the measure work described under value-based care readiness.
Connections to other care programs
A wellness visit often identifies patients who need more than a yearly plan. Someone with several chronic conditions may be a candidate for chronic care management or advanced primary care management. The clinician decides, and the list notes the decision so enrollment steps can begin.
What stays with the practice
Like other care programs, wellness visits have eligibility, consent, supervision, documentation and billing requirements that vary by payer and are confirmed by the practice. The practice also keeps:
- The visit itself and every clinical judgment in it
- The prevention plan and which screenings are appropriate for the patient
- Whether a separate problem-oriented service was provided and documented on the same date
- Final coding decisions and responsibility for claims
How an engagement starts
Get in touch through the practice support inquiry form or by calling 314-325-0126. We will ask how many Medicare patients the practice follows, how wellness visits are scheduled today and what happens to the prevention plan afterward. A first step is usually the eligible list for one clinician.
Common questions
How do we know when a patient is eligible for the next wellness visit?
From two sources checked against each other: the practice’s own record of the last visit and the payer’s eligibility information, which can show visits billed by other practices. We keep the dates on the list and flag conflicts. The practice verifies eligibility before the visit, since a visit done elsewhere may not appear in its chart.
Does this work for Medicare Advantage patients?
Yes, with adjustments. Medicare Advantage plans may use their own forms, timing rules and reporting requirements, and some run their own wellness programs. We track each plan’s requirements beside the patient’s name on the list. The practice confirms the details with each plan, and we do not tell patients what a plan pays for.
What if the visit turns up a problem that needs attention that day?
The clinician decides what to address and when. Whether a separate problem-oriented service was provided, documented and billable on the same date is a coding decision for the practice. Our role comes afterward: any order, referral or follow-up visit that results goes onto the tracked list with the other care gaps.
Who follows up when a patient declines a screening?
A declined item is recorded as declined, with the date, so it is not chased repeatedly or mistaken for an oversight. The clinician decides whether to raise it again and when. For quality reporting, the practice determines how a documented refusal is handled under each program’s rules.