Every Unfilled Care Gap Is Both a Clinical and Financial Failure
Care gap analysis serves two purposes simultaneously: it ensures patients receive evidence-based preventive care they are entitled to, and it captures the legitimate reimbursement attached to that care. Vizier calculates both dimensions — the clinical gap rate and the dollar value sitting uncaptured in your panel.
For a primary care practice with 2,000 Medicare patients, the combined uncaptured revenue from missed AWVs, depression screenings, colorectal screenings, mammography referrals, and CCM enrollment typically exceeds $400,000 annually. Vizier surfaces this by patient, by service, and by gap age — so your care team knows exactly who to call next.
HEDIS measure alignment is built in. Every care gap tracked by Vizier maps to its corresponding HEDIS measure — ensuring that closing revenue gaps simultaneously improves your quality scores for Medicare Advantage star ratings and value-based contracts.
Every Preventive Service Mapped to Revenue and Quality Measures
Annual Wellness Visit (AWV)
G0438 = first AWV, G0439 = subsequent. Requires Health Risk Assessment, updated preventive care plan, cognitive impairment screening. Often missed because 'physical' ≠ AWV.
Depression Screening
Annual PHQ-9 administration for Medicare patients. Frequently left unbilled when performed during AWV as a component rather than coded separately when done in a qualifying visit.
Diabetes Eye Exam
HEDIS CDC measure. Patients with diabetes should receive annual dilated eye exam. High care gap rate in primary care panels — typically requires referral tracking.
Colorectal Cancer Screening
Colonoscopy (45378) or Cologuard (81528, G0464). Ages 45–75. Total encounter value includes the procedure and anesthesia when applicable. HEDIS COL measure.
Tobacco Cessation Counseling
99406 = 3–10 minutes intermediate counseling, 99407 = >10 minutes intensive counseling. Medicare covers up to 8 sessions per year. Often documented but not billed.
Mammography Screening
Annual mammography for women 40+. Total encounter value includes imaging, radiologist interpretation, and any follow-up. HEDIS BCS measure. Referral tracking required.
Chronic Care Management (CCM)
For patients with 2+ chronic conditions. 20 minutes of clinical staff care management per month. Often the largest single uncaptured revenue opportunity in primary care.
Advance Care Planning
Voluntary discussion of advance directives. Medicare covers once per year. Frequently appropriate for patients 70+ with multiple comorbidities — rarely proactively scheduled.
The Medicare Annual Wellness Visit Is Not a Physical Exam
The most common AWV documentation error is confusing it with a comprehensive physical exam. The Medicare Annual Wellness Visit (G0438 for the first visit, G0439 for subsequent years) focuses on health risk assessment, preventive care planning, cognitive assessment, depression screening, and establishing a written advance care plan — not a head-to-toe physical examination.
Patients are eligible for their first AWV after being enrolled in Medicare Part B for at least 12 months, and have not received an Initial Preventive Physical Examination (IPPE, G0402) within the past 12 months. The AWV is covered 100% by Medicare Part B with no patient cost-sharing.
Vizier flags every Medicare patient who is AWV-eligible but has not been scheduled, sorted by time since last AWV and comorbidity burden — prioritizing patients where the preventive visit would generate the most clinical value and the highest care gap closure rate.
How Much Revenue Is in Your Patient Panel?
Upload your patient roster and Medicare eligibility data. Vizier calculates the total care gap revenue available in your panel, ranked by gap type, patient priority, and estimated reimbursement.