Using RN Co-Visits to Improve Access and Completion Rates for Medicare Annual Wellness Visits

Medicare annual wellness visits (AWVs) provide opportunities for regular, comprehensive assessments of a patient’s health as well as evidence-based screenings, immunizations, and health education. The Centers for Medicare & Medicaid Services (CMS) recommends that all patients with Medicare coverage receive an AWV each year. But practices often face challenges that include appointment availability, scheduling constraints, documentation burden, and patients’ lack of understanding of the importance of these visits. This article will explain how our practice overcame these challenges and improved AWV capacity and completion rates by using registered nurses (RNs) to provide annual wellness co-visits.

First, it’s important to know the differences between the three types of Medicare wellness visits, specifically who is allowed to perform each type. A patient’s first wellness visit is a distinct, one-time visit with its own requirements called the Initial Preventive Physical Exam (IPPE). It is colloquially known as the “Welcome to Medicare” visit and can only be performed during the first 12 months of a person’s Medicare coverage. The next wellness visit is known as the “initial AWV,” and all AWVs thereafter are called “subsequent AWVs.”

CMS requires that the IPPE be performed by a physician, physician assistant, nurse practitioner, or certified clinical nurse specialist. But per CMS regulations, certain other medical professionals (in addition to the above clinicians) can perform the initial and subsequent AWVs. These professionals include health educators, registered dietitians, or a team of medical professionals working under the direct supervision of a physician. Direct supervision means that the physician must be present in the office and immediately available to furnish assistance and direction throughout the service. The supervising physician is not required to be present in the exam room.

Given their scope of practice, RNs are appropriately trained to perform AWV tasks, including discussing preventive health strategies with patients and assessing their health risks, under the direct supervision of a billing physician. Our practice therefore chose to use RNs for AWV co-visits, but practices that do not employ RNs may consider using other health professionals.¹