Annual Visit Scheduling Workflow

Purpose

To guide call center agents in screening and scheduling Medicare Annual Wellness Visits (MAWVs), Yearly Physical Exams (YPEs), and Women’s Wellness Exams (WWEs), ensuring patients are scheduled appropriately based on last visit and clinical needs.

Workflow Steps

Patient Verification

• Confirm patient’s identity in Athena (name, DOB)

• Search for chart in Athena

• Determine status:

  • If Inactive or Prospective → follow New/Returning Patient Workflow

  • If Active or Established/Current with Care → continue with scheduling

Check Last Attended Visit & Apply 12-Month Rule

• Access appointment history via: Quickview → Scheduling → View Patient Appointments

• Verify attended appointments only (do not rely on scheduled/no-shows/canceled)

• Patients should not receive another annual visit within 365 days of previous annual visit

Schedule Patients Meeting 12-Month Rule

• If last annual visit was more than 12 months ago → schedule appropriate annual visit (MAWV/YPE/WWE) using provider’s scheduling guidelines

• Patient must be current with care (seen within last 24 months with PCP or specialty services, no acute needs pending)

• If no annual visit record exists but patient is current and requests one → schedule annual

Special Handling

• If patient has acute/new concerns → schedule problem-focused visit first, then annual visit after

• If patient insists on keeping annual visit despite being due for other care → schedule visit, create Patient Case, and route to PCP staff box for awareness

Review Scheduling Guidelines for PCP

• Always prioritize scheduling with patient’s PCP

• Schedule only into designated annual visit template slots

• If patient has specific requests (provider/time), create a Patient Case and send to provider’s staff box

Schedule Appointment

• Follow provider-specific scheduling rules for visit type and length

• Confirm key details:

  • Location (in-person or telehealth)

  • Language needs

  • Interpreter required

  • Insurance coverage status

• If patient requests sooner appointment or waitlist → follow Waitlist & Tickler Workflow

• Reference General Scheduling Workflow as needed

📌Key Reminders

• Do not schedule more than one annual visit within a 12-month period

• Always check patient’s chart for directives before scheduling

• Document in Patient Case when exceptions or special requests occur

• Use provider scheduling templates to ensure proper slot usage