Episode Details

In this follow-up conversation, Dr. John Pagan welcomes back Dr. Nader Rahmanian and Cheryl Rahmanian for a practical, step-by-step look at how their practice approaches the annual wellness visit — one of the highest-value touchpoints in Medicare care. From pre-visit preparation to post-visit documentation, the Rahmanians share their workflow in detail and offer their template to any colleague who wants it. Dr. Rahmanian also delivers a passionate call to action for independent physicians to engage with their medical society and clinical network.

Haven't heard Part 1? Start there for the full story of Dr. Rahmanian's 35-year career in independent practice, his candid take on employed medicine, and what it takes to build a sustainable independent practice.

Key Highlights

Making the Most of the Annual Wellness Visit Dr. Rahmanian opened with a note of genuine appreciation for Medicare's decision to cover annual wellness visits comprehensively for geriatric patients — a recognition that older patients need yearly preventive attention in a way younger patients do not. The visit is structured to cover past medical and surgical history, medication review, physical exam, psychiatric review, and — critically for geriatric patients — advanced care planning including living wills and durable power of attorney discussions. Dr. Rahmanian emphasized that the reimbursement is attractive enough that every practice should be performing these visits routinely, and that a well-run annual wellness visit combined with a regular office visit can yield close to $300 in Medicare reimbursement with relatively little additional physician time.

A Team Approach to Pre-Visit Preparation Cheryl Rahmanian walked through the practice's step-by-step preparation workflow. Annual wellness dates are tracked directly in the EMR using a pinned note. When a patient schedules their next appointment, Cheryl reviews whether they are due — always scheduling more than 365 days out to avoid Medicare timing issues. Before the visit, she researches and updates the chart, reviews preventive care status (mammograms, colonoscopies, immunizations, smoking history), and ensures the patient completes their depression screening. The nurse then sees the patient before the physician, conducts the wellness portion of the visit including the cognitive screening, and flags any deficiencies for the physician before he enters the room.

Cognitive Screening: Choosing the Right Tool Dr. Rahmanian noted that not all cognitive screening tools are accepted by Medicare for the annual wellness visit. The practice uses the MoCA (Montreal Cognitive Assessment), which meets Medicare's requirements. He cautioned colleagues that some commonly used tools — such as the clock drawing test — are not considered sufficient by Medicare, and encouraged practices to verify which assessments qualify.

Coupling the Wellness Visit with the Regular Visit A key efficiency point: the annual wellness visit can be billed alongside a regular office visit on the same day. If the physician identifies a problem during the wellness visit — a new finding, an abnormal screening result — it can be addressed and billed separately as a problem visit in addition to the wellness visit. This structure maximizes both care quality and reimbursement without requiring patients to make a separate trip.

Documentation and the Template Cheryl developed a documentation template when Medicare first introduced the annual wellness visit, building it directly from Medicare's requirements so nothing is missed. The Rahmanians offered to share this template with any PACN colleagues or Pennsylvania Medical Society members who would like it — emphasizing that it is not proprietary and is theirs to use.

At the End of Every Visit: A Preventive Care Summary Each patient