Annual Wellness Exam vs Annual Physical: The Difference Matters—a Lot

The terms annual wellness exam and annual physical may cover some of the same territory, but thinking they’re one and the same could be a costly mistake for your patient (which, of course, would be a second-hand costly mistake for you if that irate patient chooses to stop visiting your facility when they need same-day care or starts badmouthing you to their friends and family). This may be an especially complicated issue in urgent care. Medicare and Medicare Advantage plans consider the annual physicals to be a “primary care service” which may not even be reimbursable in urgent care, depending on how the contracts are structured. Medicare beneficiaries may come to your urgent care center to get the exam they think they’re “entitled to,” only to learn they’ve just voluntarily committed to a service their coverage doesn’t cover. Generally, an annual physical includes an exam given by a physician, including bloodwork and other relevant tests. The Medicare annual wellness visit may not include a physical exam, but be limited to basic measurements like height, weight, and blood pressure. Be sure that your patient understands the difference. Make sure the importance of using the correct terminology is clear to the office staff, as well.