Unclear Medicare

What is a wellness visit under Medicare Part B? Isn’t it an annual physical? No, it isn’t. That much is certain, but beyond that who knows? This video is supposed to explain the distinction.

Well, that clears nothing up. Notice how a wellness visit is annual, but a physical is routine? Uh, aren’t physicals supposed to be annual? There’s a weak explanation of what a routine physical isn’t, but not what it is.

Last year, coverage for my “welcome to Medicare” visit was denied, because the doctor’s office used the billing code for a routine physical. Knowing for certain that the initial preventive physical exam is covered by Medicare, I went through some hassles but eventually got it straightened out and the billing statement was cancelled.

This year I was once again billed by the medical practice. There were a number of things that Medicare paid for, but there was a line item that matched the amount the medical practice stated I owed. BCBS Medex paid only $8, which seemed like an odd amount. I called BCBS and all I got from the rep was, “yes, we paid $8.” Hmm. Okay, so I paid the bill for the amount I owed, because I assumed my visit was a physical. Doing that had the unfortunate effect of hiding the itemized bill from view on the Epic Systems Patient Gateway. What’s the point in doing that? Next time I’ll print it out before paying anything.

Then I watched the video shown above and called BCBS back, hoping to get more information. After the (different) rep reviewed the bill she said, “That was an annual wellness visit. I see this mistake all the time. You shouldn’t owe anything.” She put me on hold and called my doctor’s office directly. When she got back on the line I was told the bill would be re-submitted to Medicare, and assuming it goes through I should receive a refund.

There’s more information at this link and, frankly, it’s no more helpful than the video. Unless I’m missing something that’s less than obvious, it still doesn’t provide a definition for a “routine physical” under Medicare Part B.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-welflness-visits.html

The video is right about one thing — there’s confusion surrounding these definitions and their associated billing codes. So what, exactly, is a routine physical?