Did you know every physician practice is required to have a compliance plan?

Healthcare fraud is rampant in Michigan and the federal government is cracking down on healthcare practices.  An Oakland County physician practice biller was recently ordered to pay $3,252,107 in restitution and sentenced to 50 months in prison. The biller was convicted of mail fraud and of conspiracy to commit health care fraud, wire fraud, and mail fraud.

These convictions were passed down as the biller knowingly submitted fraudulent bills on behalf of a physician, for services she knew were not rendered. The physician paid her 6% of the total billings from Medicare. The case was investigated by the FBI and the U.S. Department of Health and Human Service Office of Inspector General (“HHS-OIG”). 

How can you protect your practice from fraud and fines? There are many things you can do to make sure that you don’t share this fate.

  1. One essential thing to do to for your practice is to perform an external audit to catch potential billing errors. Audits serve many functions and can help to catch mistakes before it’s too late.
  2. It is also critical that you train your staff on both HIPAA and compliance regulations, as well as on the potential sanctions that come with violations of regulations.
  3. Your staff and all physicians must also be trained on billing and coding, to make sure that physicians in your practice are not upcoding or billing for services not rendered. Physician billing and coding is under constant scrutiny from the government and insurance companies.
  4. Ensure that your practice has open lines of communication so that physicians, staff, and billers feel free to communicate their compliance concerns and questions. Make sure to have a way for all staff to anonymously report their concerns.
  5. Finally, follow through. Make sure to take all potential compliance concerns seriously. Investigate allegations and make the necessary changes to prevent further issues fr3m arising. Let your staff know that you take their compliance concerns seriously.

Always remember that compliance is an ongoing process and compliance education should be ongoing at your practice.

Contributed by: Lori-Ann Rickard of Rickard & Associates, P.C. a multi-specialty law firm serving corporate and individual clients. Rickard & Associates is a member of TPA’s Affiliate Partners program. With over 30 years of experience, Rickard & Associates has specialty practices in healthcare law, corporate transactional law, litigation, and employee relations. Rickard & Associates has certified coders who can assist in audits and/or training your staff. Contact Rickard & Associates, P.C. at (586) 498-0600. TPA members get discounts on rates!

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Monday, 11 December 2017 16:26

5 Tips for Healthy Holiday Feet, December 2017

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Don’t let sore, achy feet ruin your holiday season. Here are five tips for healthy holiday feet:

    • When hitting the dance floor and shopping malls this season, don’t compromise comfort and safety. Protect your feet from blisters, calluses and ankle injuries with the right shoes for the occasion.
    • Holiday winter wonderlands can be beautiful but also dangerous for ankles. Use caution when traveling outdoors and watch for ice or snow patches along your trail.  There is often an increase in ankle injuries during the winter months so be careful.
    • Your feet can feel the effects of too much holiday cheer—overindulging in certain foods high in uric acid can cause painful gout attacks in your feet.  If you suffer from a gout attack, call your doctor.
    • Don’t let foot pain ruin your holiday fun; inspect your feet regularly for any evidence of ingrown toenails, bruising, swelling, blisters or calluses. If you are a diabetic, the need for regular inspections increases tenfold, as the loss of sensation can mask problems that can become very serious very quickly.  
    • Reduce your risk of bacterial infections, including MRSA, during your holiday pedicure by choosing a salon that follows proper sanitation practices and is licensed by the state.

             Contributed by: Dr. Stephano Militello and Dr. Anthony Lalama of Premier Foot and Ankle located at 17900 23 Mile Rd #204 in Macomb, Michigan. They are members of The Physician Alliance, one of Michigan’s largest physician organizations                   representing more than 2,200 physicians in metro Detroit. For more health information and tips, visit www.premierfootandanklemi.com.


This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

To read additional blog articles, please visit our Blog archives page.

The Cambridge dictionary defines gratitude as "a strong feeling of appreciation to someone or something for what the person has done to help you".  Being grateful does not cost money and, according to Forbes magazine there are seven scientific benefits of gratitude that can motivate you to be thankful all year- not just throughout the holidays. 

Seven reasons to be grateful:

1. Gratitude opens the door to more relationships. Showing appreciation can help you win new friends, according to a 2104 study published in Emotion. The study found that thanking a new acquaintance makes them more likely to seek an ongoing relationship.

2. Gratitude improves physical health. Grateful people experience fewer pains and body aches and have also reported feeling healthier, according to a 2012 study published in Personality and Individual Differences. Grateful people are also more likely to take care of their health. 

3. Gratitude improves psychological health. According to Robert A. Emmons, Ph.D., a leading gratitude researcher, conducted several studies on the link between gratitude and well-being. His research demonstrates how gratitude can effectively increase happiness and reduce depression.

4. Gratitude enhances empathy and reduces aggression. Grateful people are more likely to act in a prosocial way, even when others are less kind, a 2012 study by University of Kentucky found. Participants in this study who ranked higher on gratitude measures were less likely to retaliate against other people, even when given negative feedback. They experienced more sensitivity and empathy toward other people and a decreased desire to seek revenge.

5. Grateful people sleep better.  Consider taking 15 minutes before you go to bed and write down what you are grateful for.  You just may sleep better and even longer.

6. Gratitude improves self-esteem. Some studies have shown that gratitude can help reduce social comparisons.  Instead of being resentful toward people who have more money or better jobs (a major factor in lower self-esteem), grateful people tend to appreciate other’s accomplishments.

7. Gratitude increases mental strength. Research shows that gratitude can play a role in overcoming trauma besides reducing stress. In fact, a 2006 study published in Behavior Research and Therapy found that Vietnam War Veterans who had higher levels of gratitude experienced lesser rates of Post-Traumatic Stress Disorder.  The Journal of Personality and Social Psychology found gratitude to be a contributor to resilience after the September 11 terrorist attacks. Recognizing what you are thankful for fosters resilience.

With the holidays fast approaching, now is a great time to take a moment and reflect on what you have and are thankful for every day.  This is also a wonderful time to create and find opportunities to acknowledge others for what you appreciate about them.

Source: Forbes.com, Cambridge dictionary

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance. To read previous blog articles, visit our Blog Archives page.

Healing arts encompass health sciences and forms of complementary and alternative medicine to promote healing, coping, and wellness. More cancer patients are beginning to utilize complementary therapies which in turn has had significant increase in the past several years. Complementary therapies do not replace standard therapies. Complimentary programs can be started during treatment that would not conflict with direct cancer therapy as these programs focus on the psychosocial aspect. An example of complimentary therapy would be utilizing music for patients in the oncology unit or touch therapy in radiation oncology.

Complimentary therapies can continue long after cancer treatments end, signifying a new way of living even after treatment.  These therapies can help with keeping one’s body healthy as a patient recovers and moves forward.  According to Kathy Latour co-founder of cure magazine, “our complementary approach is to help in the more subjective area of having cancer and getting through it day-to-day.” 

The use of acupuncture, touch therapies, yoga and music along with other complementary therapies can be a valuable addition to patients’ conventional cancer treatments as the medical community recognizes and focuses on the whole person and their quality of life.  Mind/body therapies can include meditation, yoga, Tai Chi to aid with movement, relaxation and overall wellness. 

Massage therapy is another aspect of integrative and holistic healing that can help improve a patient’s overall health and wellbeing. Studies on massage have shown that weekly treatments may also have an impact on one’s body’s ability to fight and contribute to a range of positive outcomes: better quality of life, improved sleep, along with mental alertness and clarity.  Massage has also been shown to help relieve pain, anxiety, depression and nausea.

Acupuncture is a complimentary treatment that is growing. With acupuncture, some side effects of the cancer treatment may be lessened.  Acupuncture has been shown to be effective in treating nausea and vomiting associated with chemotherapy.

Adding complementary therapies is about centering one’s self.  Also included in complimentary therapies are counseling and nutrition, along with support groups.  As with any type of complimentary therapies, patients should research to determine the benefits and risks of such therapies.


This blog is for informational purposes only and should not be considered medical advice. Please consult your healthcare provider for more information or if you have a medical concern.


Source: Mayo Clinic, American Cancer Society, Memorial Sloan Kettering Cancer Center, Cure Magazine

Contributed by The Physician Alliance.

To read additional blog articles, please visit our Blog archives page.



Wednesday, 13 September 2017 17:08

Good Health Reminders, September 2017

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Have you had your annual wellness visit this year?  With the end of the year approaching now is a good time to schedule a follow up wellness check if you have not already done so with your healthcare provider.  Annual Wellness Visits (AWV) include a health risk assessment that can help to identify risky behaviors, make recommendations for preventive screenings and referrals.

September is a great time to make your health a priority and to set aside time for recommended health screenings.  Are you up to date on the following age-appropriate preventive services?  Below are some recommended screening schedules:

  • Annual flu vaccine (recommended for 6 months of age and up)
  • Breast cancer screening-mammograms can detect breast cancer (recommended for women 40 years and older).
  • Pap tests can find abnormal cells in the cervix which may turn into cancer. Pap tests also can detect cervical cancer early, when the chance of being cured is high (recommended for women 21 years and older).
  • Colorectal cancer screening- identifies/finds precancerous polyps and colorectal cancer (recommended for men and women aged 50–75 years old).

According to the Centers for Disease Control, if individuals 50 years and older were screened for colorectal cancer as recommended, up to 60% of deaths from colorectal cancer could be prevented.  Treatment works best when colorectal cancer is detected early.  Regarding breast cancer screenings, early detection can save lives.  Individuals can also help reduce risks for certain cancers by making healthy life choices.  Avoid tobacco use, protect your skin from the sun, maintain a healthy body weight and limit alcohol consumption.

Your healthcare provider can advise you on a recommended schedule for applicable screenings.  It is important to share your personal health history with your provider in order to ensure proper testing.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance.

Source: Centers for Disease Control

To read additional blog articles, please visit our Blog archives page.

Friday, 11 August 2017 14:11

Opioids- Use, Misuse and Abuse, August 2017

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On an ongoing basis, local and national news are reporting that drug overdoses and opioid deaths are continuing to increase in the United States.  According to The Centers for Disease Control (CDC), a majority of drug overdose deaths (more than six out of 10) involve an opioid.  The number of Americans dying from an opioid overdose is now 91 per day.

An individual typically starts taking prescribed opioids after a fall, surgical procedure or injury to manage pain.  The rate for prescription overdoses is alarming in that it has quadrupled since 1999, yet statistics show that Americans are not reporting more pain.

Common opioid drugs include:

·         Oxycodone

·         Hydrocodone

·         Methadone

·         Fentanyl

Overdoses from prescription opioids are a contributing factor in the last 15 years for the increase in opioid overdose deaths.  It is estimated that opioid misuse and overdose cost our national economy approximately $78 billion from higher healthcare costs (treatment, productivity loss, added criminal justice costs) just in 2013.

The chart below shows four risk areas in opioid abuse and misuse in managing pain:

Source: cdc.gov/drugoverdose/images/epidemic/risk-factors

The CDC has developed guidelines for prescribing opioids for chronic pain for health care providers to follow that include evidence-based recommendations for primary care clinicians that treat patients who have chronic pain and prescribe opioids.  For more information, click on vital signs information on the CDC website.

CDC also created a new program, Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI) and is awarding $18 million over a three-year project time frame to 13 states and the District of Columbia to assist in efforts to end the opioid overdose epidemic in the U.S.

Michigan is one of the selected states chosen to participate in advancing and evaluating actions to address opioid misuse, abuse, and overdose. That includes increasing the ability to:

  • Enhance data analysis and collection of opioid:
    • Abuse
    • Misuse
    • Overdose
  • Create strategies that can have an impact on behaviors driving prescription opioid dependency abuse
  • Help communities develop more complete opioid overdose prevention programs.

As the opioid epidemic grows, CDC will continue to provide expertise along with resources to address each states’ changes in needs with regards to this crisis. The CDC also has made available patient resource tools to provide educational materials along with patient fact sheets that practices can download.  Health care providers are encouraged to discuss alternative ways to treat chronic pain in the form of nonpharmacologic therapies and nonopioid pharmacologic therapies and treatment.

The Physician Alliance is working with Blue Cross Blue Shield of Michigan and TPA physicians to increase e-prescribing of controlled substances. The initiative aims to increase the number of controlled substance (DEA schedule II-V) prescriptions submitted electronically by Physician Group Incentive Program (PGIP) physicians.

The benefits of e-prescribing controlled substances include:

  • Improved safety for all stakeholders
  • Reduction of fraud and abuse
  • Improved ability to reach meaningful use criteria (CMS requires 60% of all prescriptions be transmitted electronically)
  • Improved efficiencies and consistencies in practice workflows

E-prescribing of controlled substances requires physicians to present a two-factor authentication to prove their identity as an approved provider. Practices should contact their EMR vendor for specific education and requirements on e-prescribing.

Contributed by The Physician Alliance.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Source: Centers for Disease Control-Understanding the epidemic/record overdose deaths, Centers for Medicare and Medicaid Services-Opioid Misuse Strategy, Michigan Department of Human Services

Concussion is a common injury, especially in athletes, military and first responders, and other active patients. While most people make a complete symptomatic recovery from concussion within a few weeks, a minority of individuals will experience prolonged symptoms even after the concussion itself is over. This is called post-concussion syndrome. A very common area of confusion is understanding the difference between concussion and post-concussion syndrome and the two terms are frequently used incorrectly, often interchangeably, when describing symptoms that occur after a brain injury.

Concussion is an acute traumatic brain injury caused by an external force such as a blow to the head, face, neck, or body. This injury causes transient changes in the brain that impair neurological function and can lead to a variety of symptoms. An injury of this nature typically resolves in 1-2 weeks. Any individual with persistent symptoms beyond that time should be suspected to have post-concussion syndrome.

Post-concussion syndrome (PCS) is when symptoms persist after a concussion has resolved. Post-concussion syndrome is not a long concussion and does not signify that there has been a more severe injury to the brain. The ongoing symptoms of post-concussion syndrome can be present for a variety of reasons that tend to differ from individual to individual. Common potential contributing factors to developing post-concussion syndrome include:

  • Pre-existing neurological diagnoses (migraine, ADHD, etc.)
  • Sleep issues
  • Cervical injuries
  • Mood disorders (anxiety, depression, irritability)
  • Changes in activity level from baseline (the “unplugged syndrome”)

It is critical to determine whether concussion or post-concussion syndrome is present, as the approach to treatment is very different. Management of post-concussion syndrome requires a comprehensive evaluation to:

  1. CIarify the diagnosis and determine that the concussion has resolved
  2. Identify all contributing factors and how they interact with each other
  3. Develop a multifaceted approach to treatment

Post-concussion syndrome can be a life-altering diagnosis, affecting all aspects of a patient’s daily functioning, but it is a treatable condition in the right hands and with a comprehensive and individualized management plan.

For more information, please visit https://thesportsneurologyclinic.com/post-concussion-syndrome/.

Contributed by: The Sports Neurology Clinic at The CORE Institute, located in Brighton (8273 Grand River Ave, Suite 210) and Plymouth (44191 Plymouth Oaks Blvd, Suite 400).


This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.


According to the U.S. Department of Veterans Affairs, around 50 percent of Americans have experienced a traumatic experience and approximately 8 percent of the population will have Posttraumatic Stress Disorder (PTSD) at some point in their lives.

PTSD is a potentially debilitating condition that can occur in individuals who experienced or witnessed a serious accident, terrorist incident, combat/war, natural disaster, personal assault such as rape, or other life-threatening events.  PTSD is considered a mental health condition that can occur after someone goes through a traumatic event.

Many individuals experience stress reactions after a trauma. If the reactions disrupt a person’s life and does not go away over time, they might have PTSD. New research shows that PTSD among military personnel may be a physical brain injury, specifically damaged tissue, caused by blasts in combat.  For more information on this research, go to U.S. Department of Veterans Affairs webpage on PTSD.

PTSD is usually diagnosed when a person has experienced symptoms for at least one month to three months following a traumatic event. Symptoms may not appear for several months or years past the event.

Four main types of PTSD symptoms are:

  • Reliving the event (through nightmares, flashbacks etc.…)
  • Avoiding reminders of the event (avoidance of people, activities and certain places)
  • Negative changes in beliefs and feelings
  • Feeling jumpy (easily irritated)

A provider who is skilled in helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The National Center for PTSD has created a handout to help give healthcare providers resources for PTSD.  To raise awareness of this disorder, providers can download a printable PDF: Help Raise PTSD Awareness.

For individuals seeking information and who may already have a mental health provider, contact your provider to set up an appointment to discuss PTSD and treatment options.  If an individual does not have a mental health provider, here are some tips to find one: Where to Get Help for PTSD.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Sources:  National Institute of Mental Health, Anxiety and Depression Society of America, U.S. Department of Veterans Affairs National Center for PTSD

Thursday, 25 May 2017 17:57

Cancer Survivors Day, June 4, 2017

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Sunday, June 4 is Cancer Survivors Day and in Michigan alone there are approximately 526,100 cancer survivors according to Michigan Cancer Consortium Institute.  Nationwide that number grows to 15.5 million cancer survivors.

The American Cancer Society has developed free training opportunities for community health workers and clinicians (Online Cancer Trainings) in order to implement interventions to increase cancer screening rates.

  • Colorectal Cancer (Delivering life-saving messages)
  • Motivational Interviewing (help individuals to make healthy changes)
  • Options for Increasing Cancer Screening in Community Health Centers (CHC’s)

The Physician Alliance has created patient education posters related to breast cancer screening and colorectal cancer screening to help initiate dialogue between patients and healthcare providers (go to patient education materials webpage to order posters) regarding screenings.

Enhanced access to screenings and early detection of cancer allows for more effective intervention treatments for improved survival rates.  It is so important for cancer survivors to discuss with their healthcare providers follow up care and associated risk factors for cancer detection.

For individuals interested in getting physically active, there is a great opportunity to support cancer treatments by joining the St. John Cancer Center in participating in the annual Colors of Hope Cancer Survivor 5k run/walk at Stoney Creek Metro ParkClick here to download the flyer to register for this event that is taking place on Sunday, June 4, 2017.

Cancer resources are available through the National Cancer Survivorship Resource Center, which is a joint collaboration between Georgetown University Cancer Institute and the American Cancer Society.  One of the goals of this partnership is to improve the quality of life for cancer survivors.  This Survivorship Center provides tools for cancer survivors, caregivers and also for healthcare professionals including community advocacy and policies.

The American Cancer Society also has a toll-free number for the National Information Cancer Center for individuals to access information at 1-800-227-2345.


This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Source: Michigan Cancer Consortium, Centers for Disease Control, American Cancer Society

To read additional blog articles, please visit our Blog archives page.

Are you aware that loud noises may cause permanent hearing loss? And that close to 70% of individuals who are exposed to loud noise levels do not wear hearing protection? May is a great month to learn how to protect and prevent hearing loss.

Hearing loss is the 3rd leading chronic health condition in the United States.  In older adults, annual costs for 1st year hearing loss treatment is on the rise and expected to be near $51 million by 2030.

Help protect your hearing by:

  • Lowering the volume
  • Wearing ear protection
  • Avoiding loud, noisy places

If you have to shout to talk then the noise is too loud.  Take steps now if you feel that you are experiencing hearing loss to prevent further damage.  Additional resources regarding addressing and preventing hearing loss can be found at the Centers for Disease Control National Center for Environmental Health.  Check out their hearing loss website to download a fact sheet.

Macomb County Health department technicians will perform free hearing and vision screenings through the end of May for children aged 3-5 years old prior to entering kindergarten.  Click here for the hearing and vision screening flyer.   

Oakland County provides free hearing screenings to children 3 through 18 years old who live or attend school in Oakland County.  Screenings are by appointment only.  Click here for more information or call (248) 424-7070.

Wayne County Department of Public Health (WCDPH) also provides free hearing and vision screenings for children 3 through 18 years old. Call (734) 727-7136 to make an appointment. Free screening appointments are offered every 3rd Friday of the month.

Audiologists at the Holley Institute are providing free adult hearing screens during the month of May.  The Holley Institute, a non- profit organization is located at St. John Hospital & Medical Center Professional Building One (22151 Moross Rd, Ste 223, Detroit).  Call today to schedule a free hearing screening, (313) 343-4436.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance.

Source: Centers for Disease Control, St. John Providence Holly Institute, Wayne County Health department, Oakland County Health division and Macomb County Health department

To read additional blog articles, please visit our Blog archives page.

How to dispose of unused and expired medication, April 2017

The Drug Enforcement Administration (DEA) is joining efforts with police departments throughout the country on Saturday, April 29, 2017 for National Prescription Drug Take Back Day to safely destroy prescription drugs through convenient drop off locations. This past October, individuals turned in over 730,000 pounds of prescription drugs at nearly 5,200 sites carried out by the DEA and state and local law enforcement agencies.  

According to the Monroe MI Health department, close to four billion prescriptions are filled in the United States every year, and around one third of the prescribed and dispensed medication is unused. This relates to almost 200 million pounds of pharmaceuticals that have the potential to negatively affect the environment and risk for abuse if not properly disposed. 

Unused prescription medications should not be given to or shared with other individuals.  It is important to remember that medications should also not be flushed down the toilet or poured down drains. When disposing of medications, take off personal and identifying information on the prescription bottles.  To take advantage of communities that offer ongoing medication drop off sites, click below:

**For Wayne county residents, Wayne county will be participating in the National Take Back Initiative Day on April 29.  Anyone can check with their local police department or visit www.dea.gov to locate collection sites in your area.  The national event takes place from 10am-2pm.

Call 1-800-882-9539 or click here to find out city collection sites taking place on April 29.  Download the National Take Back Day flyer here.  For proper needle disposals, please check out safeneedledisposal.org for more information.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Contributed by The Physician Alliance.

Source: Michigan Pharmacists Association, Oakland County Sheriff Department, Macomb County Health Department, The Drug Enforcement Administration Diversion Control Division

To read additional blog articles, please visit our Blog archives page.

The title of this blog is the 2017 Theme for National Healthcare Decisions Day (NHDD) that runs through the week of April 16 through April 22. Now is a good time to talk with your doctor about future medical treatment choices prior to a life limiting event.  Regardless of age, a medical emergency can limit a person’s ability to convey type of care wanted.  Did you know that according to an American Journal of Preventive Medicine study that lack of awareness continues to be a main reason as to why individuals do not have advanced care directives in place?

What matters most to you in case of a life limiting illness?  Advanced directives include desired preferences that can be set up when you are wanting and able to clearly describe your medical preferences and to appoint a trusted person to serve as a healthcare agent.

Previous end of life treatment survey results show:

  • Most adults surveyed stated a preference to die at home, but only one-third have an advance directive expressing their wishes for end of life care (Pew Research Center, 2006)
  • More than eight-to-one (84%-10%) of the public approve of laws to let terminally ill patients make decisions regarding whether or not to be kept alive through medical treatment (Pew Research Center, 2005)
  • 2013 survey by Pew found 35% of adults stated that they have wishes in writing or have a living will

For more information, download a free advanced care directive toolkit through St. John Providence website.  Another resource is the Michigan Department of Community Health overseeing the MIPeace of Mind Registry where you can register and also download patient advocate forms.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Source: National Healthcare Decision Day, Institute for Healthcare Improvement, American Academy of Family Physicians; American Journal of Preventive Medicine, American College of Physicians, National Institute on Aging, Pew Research Center

To read additional blog articles, please visit our Blog archives page.

Annual Wellness Visits (AWV) with primary care providers is a Medicare benefit to help patients prevent or manage health care concerns/issues.  Currently, this Medicare provided benefit has no co-pay to the patient. 

Wellness visits include a health risk assessment that can help identify high-risk behaviors, and make recommendations for preventive screenings and referrals.  A physical examination is different from a wellness visit in that it is a hands on annual exam.  Medicare does not cover routine physical exams.

Guidelines to check:

History - Conduct patient history and medication list by requesting this information in advance so that documentation is completed and can be discussed when a patient enters the wellness visit.

Screen patient for depression, their safety and functional ability.  Depression screening and functional ability assessment, along with the safety screening, may be able to be managed by trained support staff in advance of the patient visit.

Cognitive assessment of patient with input from caregivers or family members who may be present during the wellness visit. Gathering impressions from the staff who obtained the patient history or performed other elements of the encounter could also be beneficial. Documentation should include evidence of assessment, such as notations of the patient's general appearance, affect, speech, memory and motor skills.

Screen for hearing and vision loss.

The wellness visit also includes checking height, weight, body mass index and blood pressure.  It is a good time to check a patient’s physical activity level and last exam date, recommend preventive screenings and check for known medical conditions.  By identifying patient behavioral risks and problems through their medical history and screenings, the AWV can be an opportunity to discuss interventions and order further screenings.  Discussion can also include education on advance care directives.

For more information go to ACP tools for wellness visits.  Billing codes for initial AWV is G0438, subsequent AWV G0439, diagnosis code V70.0.


Contributed by: The Physician Alliance, one of Michigan’s largest physician organizations serving more than 2,200 physicians in southeast Michigan.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Sources:  American College of Physicians, American Academy of Family Physicians, The Centers for Medicare and Medicaid Services (CMS)