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

Discussion created by go365moderator2 on Aug 15, 2019
Latest reply on Dec 18, 2019 by go365moderator2

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