Billing an e-visit in your medical practice: Here are six questions to consider
As today’s medical practices search for ways to increase revenue, e-visits have emerged as one potential solution. We’re talking about charging patients for asking for their physicians’ advice through the online patient portal, a service that became billable back in January 2020 using CPT codes 99421-99423. [Note that e-visits are not synonymous with telehealth, audio-only, or virtual-digital visits that may also be billable.]
Some hospitals and health systems have billed e-visits for a while, and experts say the trend may continue, ushering in widespread adoption even in medical practices. Recent studies have confirmed an uptick in these visits, particularly for diagnoses like acute sinusitis, urinary tract infection, acute respiratory infection, and hypertension.
Billing e-visits with Medicare
It's not difficult to see why billing an e-visit is appealing. Responding to patient messages through the portal was previously an uncompensated task. Now, when billing an e-visit to Medicare, physicians can earn between $14.98 and $46.60, on average, depending on how much cumulative time they spend responding to messages over a seven-day period. That’s in addition to other benefits of e-visits such as increasing patient access and potentially even lowering costs.
However, there are a few caveats and other clinical documentation and medical coding considerations when billing e-visits with Medicare, such as:
Billing an e-visit is only permitted for established patients.
Physicians must spend at least five minutes responding to a patient’s message before billing an e-visit.
The patient must initiate the service and consent to it. They must also understand they could be billed.
Billing an e-visit: Yes, or no?
Not sure whether to perform and bill for e-visits in your medical practice? Here are six questions to consider:
1. How often do patients visit and use the patient portal? Has there been a noticeable increase over time? If not, raising awareness of the patient portal may be a good first step toward laying the foundation for engagement in e-visits.
2. How often do patients who use the portal pose medical questions? What are the most common types of questions?
3. How long, on average, do physicians in the medical practice typically spend answering patient questions through the patient portal? And what is the level of physician burnout and dissatisfaction associated with this task? Billing e-visits with Medicare and other payers may make physicians more open to providing the service because they know they’ll be paid for their time.
4. How many payers pay for e-visits, and how much? Keep in mind that regulatory and insurance policies on e-visit coverage and payment are always changing. Billing e-visits with Medicare is allowed, but commercial payers may not provide this same benefit.
5. Are social determinants of health (SDOH) a barrier to patient access? E-visits, along with other types of virtual services, may help medical practices address one of the most common social determinants of health: Lack of transportation. Be sure to assess for SDOH during the Annual Wellness Visit. An added bonus? You might be able to bill for the SDOH assessment as well.
6. How might patients respond? Paying for advice through the patient portal is a new concept for patients, and it might take some time for patients to become accustomed to the idea. Patient education is critical. Consider creating a clear set of guidelines on when the medical practice will bill patients for e-visits and encourage patients to ask questions. Be prepared to explain the value of e-visits to patients and the level of expertise that’s necessary to perform them. Before initiating the e-visit itself, clearly inform patients about potential charges so they can consent to the service prior to receiving it.
Looking ahead
Will medical practices (and patients) adopt e-visits with open arms? It’s unclear, and additional research may be necessary to determine the actual effect of e-visits on costs, outcomes, health equity, and patient and clinician satisfaction. In the meantime, leveraging the patient portal in other ways can help medical practices boost efficiency. Learn how edgeMED can help.
