Annual Wellness Visit vs. Annual Physical: What's The Difference (2022)

Co-authored by Ashley Trice, AWV Product Specialist

Annual Wellness Visits (AWV) and annual physicals are incredibly important for patients, and they are often mistaken as the same service because they sound similar. However, these two types of visits significantly differ, so it’s crucial to bill patients correctly. While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient’s answers to a health risk assessment.

It does not typically include any lab work or tests requiring physical contact. Continue reading to learn more about Annual Wellness Visits and how they can be optimized for a better patient and provider experience.

Understanding the Difference

An AWV is vastly different from an annual physical, but they are often mistaken as the same type of visit. The only way to use these terms correctly is to learn what distinguishes them from each other. In this blog, we will explore what sets an AWV apart from an annual physical, and why it’s important to know the difference.

What Does a Wellness Visit Cover?

The belief that AWV are the same as annual physical exams is a common misconception in the medical industry. This likely comes with most people being familiar with annual physical exams or checkups and assuming that an AWV is the same thing. However, they are quite different.

Medicare’s Annual Wellness Visits (AWV) are annual preventive visits for patients to create or update a personalized prevention plan. These preventative visits are designed to let the patient explain to their provider how they feel about their health status by filling out a health risk assessment. The provider can then use the collected information to identify risk factors, suggest appropriate preventive services, and create a personalized prevention plan for the patient.

(Video) Medicare Annual Wellness Visits vs Annual Physical - What's the Difference?

These visits are comprised of three main components:

  1. Health Risk Assessment (HRA) – The first component of an AWV entails patients completing a self-administered questionnaire that addresses all facets of their health and well-being. For the HRA to be deemed compliant, patients must self-report information on the following topics:
    • Demographics
    • Self-Assessment of Health Status
    • Behavioral Risks
    • Medical History and Family Health History
    • Psychosocial Risks
    • Activities of Daily Living
    • Instrumental Activities of Daily Living

The risk-assessment questionnaire may also include questions about advance care planning. Based on the patient’s answer to the HRA questions, the provider can identify risk factors, such as cognitive impairment, and create a personalized prevention plan to follow.

  1. Vitals – The second component is collecting and documenting vitals. These routine measurements include height, weight, and blood pressure which are essential to analyze when discussing risk factors related to cardiovascular disease, stroke and hypertension. Height and weight are used to calculate and report on body mass index (BMI).
  2. Consultation – The third component of an AWV consists of translating the HRA results into a five to ten-year care plan. Based on patient responses in the questionnaire, providers can identify risk factors and discuss a preventative plan of action geared toward a healthier future.

The Difference Between an Annual Wellness Exam Versus a Physical

Let’s take a look at the differences between AWVs and annual physicals in the table below. One of the most significant distinctions is that a physical exam is more extensive than a wellness visit. An AWV mainly consists of assessments and does not require a physical exam, but an annual physical does require an AWV.

Keeping the main distinction between these two exams in mind, it is easy to understand the other differences since there is no physical touch involved in an AWV but there is during a physical. For example, you would not perform blood work during an AWV since physical touch is involved.

Annual Wellness VisitAnnual Physical
Medical HistoryX
Physical ExamX
Review of risk factors for illnessX
Bloodwork, lab testsX
Personalized prevention planX
Medication reviewX
Address new health problemsX
VaccinationsX
Co-paymentX
(Video) How is an annual wellness visit different from an annual physical?

During an AWV, a health care provider reviews a patient’s medical history and evaluates their risk factors for various illnesses. They will read a patient’s responses to the health risk assessment and confirm their family and medical history. This information will help them determine risk factors and any prevention measures the patient may need to take. An AWV also lets the provider check a patient for any signs of frailty, dementia or memory loss.

The health care provider also reviews a patient’s medications during an AWV and develops a personalized prevention plan that documents potential risk factors, available treatment options and individualized health advice. The prevention plan includes a screening schedule for preventive services to help the patient maintain their health and prevent potential illnesses.

(Video) Annual Wellness Visits (AWV) Video

An annual physical includes a wellness exam and a full physical exam including blood work, lab tests and vaccinations. During an annual physical, a health care provider addresses any new health complications a patient is experiencing. They also order any preventive tests such as cancer screenings the patient may be due for.

One of the other important differences between the two is that there is no coinsurance required for an AWV as Medicare covers this service fully, and reimburses providers for it. Medicare does not reimburse providers for annual physical exams.

What Is Not Discussed in an Annual Wellness Visit?

While a provider evaluates a patient’s overall health to create a personalized prevention plan during an AWV, this type of visit does not include any discussion about treatment for current illness or chronic illnesses.

If a patient discusses current symptoms they are experiencing and receives care, a treatment plan or a prescription, they are charged a deductible or copay for that service. For example, if a patient receives care for abdominal pain or a prescription to treat an infection, this is considered a separate service not included in the wellness visit.

Treatment for chronic illness is also not included in an AWV. If a patient discusses a chronic illness with their health care provider during their visit or receives a prescription or treatment plan for their chronic illness, they are charged a deductible or copay. Chronic illnesses can include conditions such as diabetes, high blood pressure and high cholesterol.

What are the qualifications for Annual Wellness Visits?

So, who qualifies to receive an AWV? Let’s begin with identifying eligible patients. Medicare beneficiaries qualify to receive an Annual Wellness Visit from their provider, completely free of charge every year. However, the patient must be enrolled in Medicare Part B along with Medicare Part A (or Original Medicare) to reap the benefits of preventive health care services. Patients with Medicare Advantage plans are also eligible to receive preventive services such as AWVs, as long as they see an in-network provider. Ultimately, eligibility comes down to these two things:

(Video) What is an annual wellness visit?

  • The patient has been enrolled in Medicare Part B services for over 12 months
  • And, the patient has not received an AWV or the Welcome to Medicare preventive visit in the past 12 months

There are also requirements surrounding who is eligible to offer Medicare AWVs. This is great news if you are a primary care facility because you qualify to perform AWVs with your patients! But, you are not the only eligible provider able to offer this service. Specialists such as neurologists, cardiologists, rheumatologists, etc. qualify as well. Even urgent care clinics qualify to perform this service. However, since only one AWV can be done per patient, per year, a patient will not be eligible if they have already had their preventive visit with another provider.

Annual Wellness Visit vs. Annual Physical: What's The Difference (1)

Understanding the “Why”

So, why are Medicare Annual Wellness Visits valuable to health care providers and their patients? As the shift in health care from volume-based care to value-based care continues to grow in importance, preventive services like AWVs are crucial. AWVs are preventative services that identify gaps in care and improve the quality of care that providers deliver. In addition, they are proven to improve patient outcomes and reduce costs:

  • There’s a 105% increase in colorectal cancer screenings for patients who get an AWV.
  • There’s a 58% increase in pneumonia vaccinations for patients with an AWV.
  • There is a 46% increase in breast cancer screenings for patients who get an AWV.
  • A patient who receives an AWV improves medical outcomes resulting in $570 less annual Medicare expenses.
  • 1,000 patients with an AWV can deliver more than a quarter million dollars in annual ACO shared savings*

These statistics show us the importance of preventive services like Medicare annual wellness visits. By conducting AWVs, health care providers can prevent future health problems and change the outlook of our health care industry as a whole.

Upgrade Your Annual Wellness Visits

Upgrade your practice or hospital’s annual wellness visits with innovative software to gather important data and save time. RapidAWV™ software makes it easy to conduct wellness visits. This software lets providers connect with patients and collect data without interrupting practice workflows.

With customizable questions and a user-friendly format, patients can easily complete Health Risk Assessments so providers can create the best prevention plans possible. RapidAWV™ also completes accurate eligibility checks with a real-time eligibility verification feature, so you will always be aware of eligible patients.

(Video) What is an Annual Wellness Visit?

Contact ChartSpan to Optimize Your Annual Wellness Visits

ChartSpan can help you optimize your billing process for Annual Wellness Visits to save you time while you provide excellent patient care. Optimize the AWV process with ChartSpan’s RapidAWV™ software.

This innovative technology lets patients complete a health risk assessment in as little as 10-15 minutes so they can easily work with their provider to build a proactive health plan. RapidAWV™ software operates with special reporting logic that presents the most critical data first so providers can access important information quickly and easily.

Contact ChartSpan to learn more about RapidAWV™ software.

FAQs

What is the difference between a wellness exam and a physical? ›

A physical exam helps your doctor figure out what the problem is and what needs to be done. When you're healthy and feeling good, you want to stay that way. A wellness exam helps your doctor understand what's working for you and how to best support your continued health and well-being.

What is performed during an annual physical? ›

Highlights of an Annual Physical

Vital signs- Including your blood pressure, heart rate, respiration rate, and temperature. General appearance- This includes the way your skin looks, your posture, as well as memory and other mental acuity.

What is not included in a wellness visit? ›

Your insurance for your annual wellness visit does not cover any discussion, treatment or prescription of medications for chronic illnesses or conditions, such as high blood pressure, high cholesterol or diabetes.

What does an annual wellness exam include? ›

What is included in a wellness exam?
  • A physical examination.
  • Checking your vitals.
  • Checking BMI.
  • Examination of personal and family medical histories.
  • Discussion of current lifestyle and health choices.
  • Screenings.
  • Shots and immunizations.
  • Establishing a plan for your health.

What is an annual wellness visit? ›

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors.

Is bloodwork part of an annual physical? ›

There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely: Complete blood count.

Why is an annual physical exam important? ›

An annual physical exam lets you and your doctor assess how you are doing health-wise regardless of whether you are feeling symptoms or not. It can also help you assess which areas of your health need attention so they don't cause bigger issues later on.

Does a Medicare Annual wellness visit include a physical exam? ›

The yearly “Wellness” visit isn't a physical exam.

Your doctor or other health care provider performs additional tests or services during the same visit. Medicare doesn't cover these additional tests or services under this preventive benefit.

What is a wellness physical? ›

An annual wellness exam or visit is an important part of preventative care. These annual visits with your primary care doctor allow for a yearly health assessment to make sure you are in good health and catch any issues that may arise early.

What happens at a wellness visit? ›

Your doctor will ask questions about your weight, height, blood pressure, body mass index (BMI), and discuss your health choices and current lifestyle. The visit may also include different types of screening depending on your gender, risk, and age.

What does a physical exam consist of? ›

A thorough physical examination covers head to toe and usually lasts about 30 minutes. It measures important vital signs -- temperature, blood pressure, and heart rate -- and evaluates your body using observation, palpitation, percussion, and auscultation.

Is a well woman exam the same as an annual physical? ›

Your wellness visit is all about you, your body, and your reproductive health. Wellness visits are also called gynecological exams, pelvic exams, annual exams, or well woman exams.

What is a routine physical exam? ›

A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check. You don't have to be sick to request an exam.

What is the difference between a physical and a well woman exam? ›

While a standard physical exam is more focused on overall health, a well-woman exam (also called a gynecological exam) is designed to zero in on health issues that are specific to the female reproductive health.

Do you have to take your clothes off for a physical? ›

For annual physicals, patients will be gowned, so they shouldn't wear constricting, hard-to-remove clothing.

What does having a physical mean? ›

A physical exam, or a physical, is a routine test wherein a healthcare professional inspects, feels, or listens to different parts a person's body. Other names for a physical include a complete physical exam, a routine physical, and a checkup.

What is a routine physical exam? ›

A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check. You don't have to be sick to request an exam.

Videos

1. Does Medicare Cover An Annual Physical? | (Tips that can save you $$ !)
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2. Security Health Plan Academy: Your Annual Wellness Exam – What You May or May Not Know
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3. SAMA - Physical Exam vs Medicare Annual Wellness Visit
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4. Medicare Annual Physical? Better WATCH OUT!
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5. Wellness versus Physical for the Medicare Patient
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6. Medicare Wellness Exam vs. a Physical - What Does Medicare Pay? [Explained]
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