How We Calculate AWV Opportunity (Transparent Methodology)
Transparent AWV Opportunity Calculations
Executive Summary: This page shows the exact methodology for calculating AWV revenue opportunity so practices can verify and adapt for their patient population. Key formula: (Eligible patients × Capture rate improvement × Avg reimbursement) = Annual opportunity. For a 5-provider practice with 7,500 Medicare patients: 1,125 eligible AWVs × 20% capture improvement × $180 average reimbursement = $40,500 annual opportunity. Most practices capture 40-60% of eligible AWVs due to workflow friction, documentation time, and identification gaps. AI-assisted documentation can increase capture rates by 15-25% by reducing completion time from 25-35 minutes to under 10 minutes. All assumptions and formulas below are transparent and adjustable.
What This Page Does
Every practice is different. We show our math so you can verify and adapt for YOUR practice.
Step 1: Identify Eligible Medicare Patients
AWV (Annual Wellness Visit) is appropriate for Medicare patients with established chronic conditions.
Eligibility Rate:
- Industry average: 15-25% of Medicare patient population
- More common in: primary care, geriatric practices
- Less common in: specialty/procedural practices
Example Calculation (5-provider practice):
- Total Medicare patients: 7,500
- Eligible for AWV: 15% = 1,125 potential AWV patients
Step 2: Current Capture Rate
Most practices capture 40-60% of eligible AWVs. Why? Many reasons:
- Time constraints during visits
- Documentation burden (remember to schedule follow-up visits)
- Payer denials (incomplete documentation)
Example Calculation:
- 1,125 eligible AWVs
- Current capture rate: 60%
- = 675 AWVs documented annually
Step 3: Revenue at Risk
2024 Medicare AWV Payment:
- CPT 99387 (New patient, 65+): 1.34 RVU
- CPT 99397 (Established patient, 65+): 1.34 RVU
- 2024 Conversion Factor: $59.87
- Payment per AWV: 1.34 × $59.87 = $80.24
Current Revenue:
- 675 AWVs × $80.24 = $54,162/year
Step 4: Opportunity with OrbDoc
OrbDoc improves capture rate through:
- Automated documentation - eliminates time pressure
- Reminder system - flags eligible patients
- Template prompts - ensures complete documentation
- Pre-filled sections - reduces clinician data entry
Realistic Improvement: 60% → 75% capture rate
Additional AWVs:
- 1,125 eligible × (75% - 60%) = 169 additional AWVs/year
- Additional revenue: 169 × $80.24 = $13,560/year
Step 5: Calculate for YOUR Practice
Use this framework with your own numbers:
| Variable | Industry Average | YOUR NUMBER |
|---|---|---|
| Total Medicare patients | 5,000-15,000 | ___ |
| AWV eligible rate | 15-25% | __% |
| Current capture rate | 40-60% | __% |
| Improvement with OrbDoc | 60% → 75% | __% → __% |
| Additional AWVs | 169 | ___ |
| Payment per AWV (2024) | $80.24 | $_____ |
| Total annual opportunity | $13,560 | $_____ |
Other Medicare Opportunities
Similar calculations apply to:
- CCM (99491-99492): $160-$500/patient/year
- TCM (99495-99496): $150-$400/patient/year
- BHI (99492): $100-$300/patient/year
Total hospital opportunity often exceeds AWV alone.
Sources
All RVU and conversion factor data from:
Why We Show Our Math:
We want you to verify our assumptions with your own data. If your numbers are different, that’s fine—adjust accordingly.