Can a Medicare Annual Wellness Visit Be Performed by a Nurse Alone?
For Federally Qualified Health Centers (FQHCs), the Medicare Annual Wellness Visit (AWV) offers an opportunity to deliver comprehensive preventive care while also receiving enhanced reimbursement—around 137% higher than standard Medicare visits. However, many clinicians wonder if these visits can be performed by a nurse alone, without a provider’s involvement, to streamline the process.
CMS Guidance on AWV Requirements
Recently, BCA reached out to the Centers for Medicare & Medicaid Services (CMS) to clarify this question. According to the reply we received from CMS, an AWV can be billed as a stand-alone visit only if it is the sole medical service provided that day by an FQHC practitioner. This means that a nurse, such as an RN, cannot independently perform an AWV as a separately billable visit. If the AWV is furnished by a medical professional who is not a provider, it may be part of another medical visit but is not billable as a separate encounter.
Why This Matters for FQHCs
Medicare AWVs are important for patient care and FQHC revenue. While these visits require time and adherence to specific Medicare criteria, they allow FQHCs to address preventive health needs comprehensively. Ensuring the AWV is provided by an eligible practitioner within the FQHC means the visit can be billed separately, thus maximizing revenue and improving patient outcomes.
Balancing Time and Quality in AWVs
Clinicians may feel burdened by the AWV requirements, but understanding the billing rules helps optimize resources without compromising compliance. Having an FQHC practitioner conduct the AWV ensures proper reimbursement and meets CMS requirements, allowing clinics to benefit financially while providing valuable preventive care.
For more details on Medicare billing and coding compliance or to address specific billing questions, reach out to our team at BCA. We specialize in helping FQHCs navigate Medicare regulations and maximize their value-based care strategies.
If you still have questions or would like more guidance or training on Annual Wellness Visits, please contact us at info@bcarev.com. We’re here to support your team in delivering efficient, compliant care.