Why am I not being awarded for an Annual Wellness Exam?

Discussion created by go365moderator2 on Aug 15, 2019

Go365 is able to award Medicare members for a Medicare Annual Wellness Exam (also called an Annual Wellness Visit), and NOT a physical. It all depends on how the provider bills Humana. Please see below for information on the differences:


Annual Physical (Not currently eligible for rewards)

  • Doctor will measure height and weight
  • Doctor will take your blood pressure
  • Doctor will measure BMI
  • Doctor will review your medical and family history
  • Doctor will assess your risk factors for preventable diseases
  • Doctor will check vital signs
  • Doctor will perform head and neck exam
  • Doctor will perform lung exam
  • Doctor will perform abdominal exam
  • Doctor will perform neurological exam
  • Doctor will test your reflexes
  • Doctor may submit urine and blood samples for lab testing

Medicare Wellness (Eligible for rewards with Go365)

  • Doctor will measure height, weight, blood pressure and other routine measurements
  • Doctor will review your medical and family history
  • Doctor will assess your risk factors and treatment options
  • Review Health Risk Assessment questionnaire
  • Updating list of providers and prescriptions
  • Looking for signs of cognitive impairment
  • Doctor will set up a screening schedule for appropriate preventive services

The Medicare Wellness exam includes the assessments, but none of the "physical" tests where the doctor has to physically touch you.  Under Medicare, a doctor will only perform these types of services if there is a specific diagnosis or symptom which necessitates that type of examination. Other preventive services will be scheduled, but not performed, during your wellness visit.  You can find a complete list of covered preventive services under Medicare here


Source: communitycare.com